X
A A A
GO

AManaaki mahi tahi

  • About
  • Acute Plan
  • Personalised Care Plan
  • Latest News

The Shared Care Planning team transitioned to Pegasus Health in February 2023.

Shared Care Planning describes a way of working which involves community, primary and secondary health services working together to proactively manage and plan care with patients who have complex needs.

Shared care plans enable coordination and improved communication between primary, secondary and community health services and real time information sharing. The shared care plans are accessed through HealthOne and Health Connect South and include the Acute Plan and the Personalised Care Plan.

The Shared Care Planning work focuses on design, implementation and education about shared care plans to encourage the use and integration of the Acute Plan and the Personalised Care Plan throughout the South Island.

The acute plan:

  • is a patient-centred plan which documents the:
    • patient’s underlying complex health conditions, and
    • management of exacerbations of underlying complex health conditions for health providers unfamiliar with the patient.
  • is for patients with moderate to high risk of attending acute services over the next 12 months.
  • aims to support rapid, safe management of patients with complex health conditions, and those who are at moderate to high risk of attending acute services over the next 12 months.

The information is intended to support decision making, regarding the need for admission, investigations, and appropriate setting for acute care.

Contributors may complete only the parts of the plan that they are familiar with, and request colleagues to complete it. The completed plan is shared electronically across the Canterbury health system.

View some demo videos on how to create, edit and print acute plans. 

The Personalised Care Plan:

  • aims to support patients to work with care teams to coordinate care around their needs and priorities and to make the goals and activities visible to other clinical teams.
  • is a patient-centred plan which documents:
    • problems the patient currently experiences
    • what they want to achieve with regard to their health or general well-being, and
    • actions the patient and their care team are going to take to achieve these goals.
  • is for patients who have moderate to high complexity health needs, including:
    • frailty
    • 1 or more chronic conditions
    • complex social and medical needs
    • palliative care
    • long-term significant disability.
  • can be created or updated by any clinician.

Plans can focus on a small subset of the patient’s health care or be created across a range of different conditions.

The completed plan is shared electronically across the Canterbury health system.

View some Personalised Care Plans demo videos

Latest News
22Dec

Canterbury’s use of Acute Plans during covid-19 highlighted at hui

22 Dec, 2020 | Return|

Canterbury Clinical Network Senior Project Facilitator Rebecca Muir presented at the Ō tātou hiranga | What matters to us: Shared decision making and advance care planning virtual Hui held early December. 

Rebecca’s presentation titled, ‘Capturing key medical information to protect vulnerable people during lockdown,’ shared how the Acute Plan was used across the Canterbury health system during lockdown. 

“The focus was on how the Acute Plan was used to document important conversations and key medical decisions for patients at increased risk of health deterioration, and the versatility of the Acute Plans across different settings and scenarios,” says Rebecca. 

The presentation was well received with 61 people virtually joining the presentation. 

“There were a wide array of questions ranging from, wanting to know what detail is captured in the acute plan, whether it is available in the North Island and in other South Island regions, and who can access the plans.”

“The hui was an engaging and thought provoking two days of discussions and exploration about our role in making sure what matters most to our patients and their whānau is at the centre of our health care planning and delivery.”

Sessions included several consumer stories, advance care planning and experiences particularly around how planning is and could be done with people with learning and cognitive disabilities.

View Rebecca’s virtual presentation video here and slides here.

About the Author

Related

All you need to know about Personalised Care Plans

All you need to know about Personalised Care Plans

Electronic shared care plans are ‘living documents’ which give multiple professionals across diffe...

Read More >
Newest shared care plan gets personal

Newest shared care plan gets personal

The newest in the suite of electronic shared care plans, the Personalised Care Plan (PCP), goes live...

Read More >
Reducing stress in times of need with Shared Care Planning

Reducing stress in times of need with Shared Care Planning

When you’re not well it can be stressful and communicating is not always easy, which can sometimes ...

Read More >
Rebecca Muir presenting at Digital Health Week NZ conference

Rebecca Muir presenting at Digital Health Week NZ conference

CCN is proud to share that Shared Care Planning Programme Lead and Product Manager Rebecca Muir will...

Read More >
Shared Care Plans webinar - who should have one, how to use one, why it matters

Shared Care Plans webinar - who should have one, how to use one, why it matters

A webinar providing in-depth information about the suite of shared care plans available is scheduled...

Read More >
Electronic shared care plans live across the South Island

Electronic shared care plans live across the South Island

A suite of electronic shared care plans is being rolled out across the South Island, with more than ...

Read More >
Useful resources

Shared Care Plans brochure

Making a plan for your health and wellbeing. 

VIDEO: using shared care plans

A webinar which walks through the plan and demonstrates how to use them.

PCP tips and tricks

Personalised Care Plan information, including tips and tricks. 

Acute Plan tips and tricks

Acute plan information, including tips and tricks.

Shared Care benefits

Sharing the benefits of Shared Care Plans with Pasifika Matua.

Shared Care Plans

Frequently asked questions about Shared Care Plans.

Identifying vulnerable patients

A guide to help identify patients who may benefit from a shared care plan.