High Intensity Support Notes: Real Examples for Complex NDIS Care

Last updated 2026 · SupportNotes · Made in Australia

What makes a high intensity support note different?

If you work complex or high intensity shifts — PEG feeds, complex bowel care, seizure management, tracheostomy, catheter care, subcutaneous injections, complex wound care — your progress notes carry more weight than a standard personal-care log. They sit alongside the participant's health protocol, and they can be read by a registered nurse, a GP, the NDIS Commission, or the worker who takes over from you at handover.

The difference is simple: a high intensity note has to prove two things at once. First, what actually happened to the participant (observations, response, any change). Second, that you delivered the support safely and within your training, following the participant's specific plan. An auditor isn't just checking that you wrote something — they're checking that the note matches the health protocol and the High Intensity Support Skills Descriptors for that task.

You don't need fancy clinical language or perfect English. Plain, accurate, specific words beat impressive-sounding vague ones every time. "Drained slowly, no leaking, obs normal" is worth more than "feed went well."

• Be objective — write what you saw and measured, not what you assumed or felt
• Be measurable — times, amounts (mL), counts, temperature, what you used
• Show the protocol — note that you followed the participant's plan for that task
• Show your limits — when something was outside your scope, you escalated, not improvised
• Be contemporaneous — written during or right after the shift, not from memory later

The 5-part structure that keeps every note audit-ready

You can write a strong high intensity note in under two minutes if you follow the same five-part shape every time. It works for a quiet PEG feed and for a seizure emergency.

Think of it as O-A-R-E-S: Observation, Action, Response, Escalation, Sign-off. Once it becomes a habit, you stop staring at a blank box wondering what matters.

• Observation — what you saw before and during the support (site, skin, output, behaviour, obs)
• Action — exactly what you did, including the protocol step and any equipment/amount
• Response — how the participant responded (tolerated it, distressed, settled, refused)
• Escalation — who you contacted, when, and what they advised (or 'no escalation required')
• Sign-off — full name, role, date and exact time, written same shift

PEG feed: rough note vs audit-ready note

This is the most common high intensity task that gets under-documented. A one-line "PEG feed given" tells a nurse nothing about tolerance, site condition, or whether the participant was sat up safely.

Notice how the audit-ready version names the amount, the position, the site check, and the response — the things that matter if the participant later has reflux, aspiration, or a site infection.

Complex bowel care: rough note vs audit-ready note

Complex bowel care is high-risk: errors can lead to impaction, infection, or autonomic dysreflexia. Your note needs to show you followed the participant's bowel protocol and watched for warning signs — not just that 'bowels were opened.'

The audit-ready note records the method used (per plan), the result, and crucially that you monitored for the danger signs the protocol flags.

Seizure event: rough note vs audit-ready note

For epilepsy and seizure support, the note becomes a clinical record the treating team relies on. The single most useful thing you can capture is the duration and what the seizure looked like — because that decides whether emergency medication or an ambulance was needed.

The audit-ready version times the seizure, describes it objectively, records the protocol response, and documents escalation. Never write 'had a fit, seemed fine.'

Clinical observations and 'nothing happened' shifts

Two situations trip people up: recording vital signs/observations, and writing a note when the shift was uneventful. Both still need real detail.

For observations, write the actual numbers and compare to the participant's normal range — a temperature of 38.4 means nothing to the reader unless they know it's above Janelle's baseline. For a quiet shift, 'all good' is not a record. State what you checked and confirmed stable, because a calm note still proves the support and monitoring happened.

• Observations: record exact readings — temp 37.0, BP 118/76, SpO2 97%, resp 16 — and note if within the participant's normal range
• Compare to baseline: 'slightly above Tom's usual, will recheck and monitor' beats a bare number
• Uneventful shift: 'PEG site checked twice, no redness; catheter draining clear, no odour; ate independently; no concerns' is a valid, useful note
• Refusals count: if a participant declines a support, record it, the reason given, and how you responded — never just skip it
• Avoid copy-paste: identical notes shift after shift are a red flag to auditors; describe today, not yesterday

Where high intensity notes go wrong (and the quick fix)

Most rejected or risky notes fail for the same handful of reasons. None of them are about your English — they're about habit. Fix these five and your documentation jumps from a liability to an asset.

The biggest one is timing. A note written from memory three days later is both less accurate and far weaker as evidence. If your service lets you log on a phone or tablet at the point of care, use it.

• Vague verbs — 'managed', 'dealt with', 'assisted' say nothing; name the actual action
• Missing amounts and times — 'a feed' vs '250mL over 30 mins at 0730'
• Opinions stated as fact — write 'declined breakfast, said he felt unwell', not 'was being difficult'
• Going outside scope silently — if the task wasn't in your training or the plan, you escalate and record it
• Late entries — write same shift; if you must add later, mark it a late entry with the time you wrote it

Write your next note in seconds — free tool

Knowing the structure is one thing; hitting it on a busy complex shift is another. We built a free progress note helper that walks you through the O-A-R-E-S structure, prompts you for the clinical details high intensity tasks need (amount, site check, obs, escalation), and outputs a clean, objective, NDIS-ready note you can paste into your system.

It's free, it's ESL-friendly, and it never stores participant names. Try it before your next shift and turn five rough words into an audit-ready record.

• Prompts you for the details that matter on PEG, bowel care, seizure and catheter shifts
• Keeps your wording objective and plain — no fabricated clinical claims
• Built for real shift conditions, on your phone, in under two minutes

Frequently asked questions