Table 2 Exemplar quotes of further influences upon case note review
From: Impetus to change: a multi-site qualitative exploration of the national audit of dementia
Dimension | Exemplar quote |
|---|---|
Goals | “We are a little bit fearful because, ultimately, if we were shown not to be making a difference, then what does that say about our team? We haven't done our job? Would our roles be in jeopardy because we haven’t made a difference?” … “if I gave it to the tissue viability team, ‘Why the hell should I audit them?’ Can you imagine if we gave them X amount of notes? They probably would rush through it, and the results would be more negative – because they don’t have a vested interest in the results. I do have a vested interest in the results. That means that, ‘Is this accurate?’ I don’t know.” (Interview 14, dementia nurse specialist) |
Quality of records | “There’s one (question) around, ‘Is there any evidence in the notes that the discharge plan was discussed with the consultant?’ But nobody writes that.” (Interview 27, dementia nurse specialist) |
Expectations | “There is certainly an element of, when you expect something not to be there, you don’t look as hard. I suppose there is an element of it, maybe subconsciously, for instance, if I know that there is always a discharge letter and I don’t find it immediately, I will delve deep until I find it. If I didn’t find a ‘This is me’ (patient/carer assessment) after looking through the notes at a cursory glance, would I go that extra mile? Maybe not.” (Interview 14, dementia nurse specialist) |
Interpretations | During observation 22, the participant verbalised different reasons for recording absence of pain assessment, saying out loud that: it was “not done consistently”, “no expressed pain … recorded, but they haven’t used a tool”, “they’ve put zero but he’s drowsy. They haven’t said whether he’s capable of answering or not” (Observation 22, record review). In contrast, a different reviewer was more lenient in their assessment of practice, deciding that a pain assessment had been undertaken based upon a thumbnail size image where it was possible to see a signature, but not the content of the assessment (Observation 23, record review). A further reviewer interpreted that, if nursing observations are there, then the patient must have had a pain assessment (Observation 17, record review). |