Defensible Documentation Training

Defensible documentation training is delivered by live interactive webinar and onsite to groups of up to fifteen delegates. It is designed to give attendees a better understanding of the principles of good communication and record keeping. Effective communication skills are essential when working in the healthcare sector.  The CQC look to this as a key indicator of a good practice.

Target Group

Defensible Documentation Training is targeted at managers, nurses, team leaders, HCA’s and support workers who work in hospitals, care homes, community teams, mental health units, learning disability units, domiciliary agencies and voluntary organisations.

Learning Objectives

• Raise awareness of importance of keeping defensible and accurate electronic and paper records.
• Understand the purpose and principles behind quality written information.
• Recognise information that is appropriate and inappropriate for recording.
• Identify effective and appropriate ways of presenting information.
• Understand the need for, and the limits of, confidentiality.

Course Content

Defensible Documentation Training consists of the following topics:

• Why do we need defensible documentation training?
• Written records for healthcare and independent care.
• Good practice guidelines.
• What should and should not be documented.
• Taking and making accurate records.
• The use of ‘plain English’ and minimising the use of jargon.
• Keeping records secure.
• Confidentiality and GDPR.
• Principles of the GDPR.
• Defensible documentation.
• Legalities
• The potential consequences of poor record keeping.

Defensible Documentation Training Assessment and Certification

Assessment is carried out by the trainer throughout the course.

On successful completion of the course students will receive a certificate of attendance which is valid for three years.