Coordinated Care
Coordinated Care
The Coordinated Care domain tests how the practical nurse organizes and prioritizes care, communicates within the interprofessional team, delegates safely, obtains and documents consent, and plans transitions. Questions often ask for the first or best action when several tasks compete.
Prioritization, assignment, and delegation
- Use ABCs, then Maslow, then client preference; unstable clients are assessed by the nurse first.
- Delegate only stable, predictable tasks with a known outcome (e.g., routine vital signs on a stable client, ambulation of a stable client). Never delegate assessment, teaching, evaluation, medication administration, or anything requiring nursing judgment to an unregulated care provider.
- The PN remains accountable for the delegated task and follows up.
- Hand off using ISBAR: Identify, Situation, Background, Assessment, Recommendation. Read back verbal orders.
- Escalate through the chain of command when a concern is not addressed.
Consent, documentation, and transitions
- Informed consent requires capacity, disclosure, understanding, and voluntariness. The person performing the procedure obtains consent; the PN reinforces teaching, witnesses, and documents.
- Use a substitute decision-maker when the client is incapable; emergency treatment can proceed without consent to save life or prevent serious harm.
- Document objective, timely, factual entries; incident reports go to risk management, not the health record.
- Discharge planning begins on admission and includes medication reconciliation and teach-back.
Worked example
A care aide reports that a client with pneumonia is newly confused and has a temperature of 38.6 C. The PN should not delegate the assessment back to the aide. New confusion plus fever suggests deterioration or delirium. The PN assesses vital signs, oxygen saturation, and mental status, stays with the client, and calls the physician using ISBAR: "I am calling about Mr. X in room 12; he is newly confused and febrile; his baseline was alert; his BP is 100/60, HR 110, SpO2 92%; I recommend you see him now and consider sepsis screening." The PN documents and initiates prescribed orders.
Traps that cost marks
- Delegating a task because the unit is busy, then not following up.
- Accepting a verbal order without read-back.
- Documenting "incident report completed" in the progress note.
- Assuming a capable client's refusal can be overridden by family.
- Treating the physician's reluctance as the end of the chain of command.