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Despite its importance, case recording is often the first thing sacrificed if time is short. However, a peer audit scheme in Reading looks set to change all that. Graham Hopkins reports.

Thursday 03 February 2005 00:00

Recording is an integral part of social care work but is a task that is not met with undiluted enthusiasm. If anything it can be resented ("I'm not a typist"), as seemingly increasing paperwork takes more time away from "real" work with service users. Neither are staff trained to record effectively - often they are just expected to know how to do it.

Nonetheless, workers do understand its importance. Recording has several purposes: it provides evidence of an organisation's involvement with a service user and the standard of service; helps with continuity when workers are unavailable or change; provides evidence for planning, and allocating resources; and supports supervision and professional development.

However, workers can be sceptical about new systems or audits that are imposed from outside or above. So, the refreshingly simple solution adopted by community care services in Reading, Berkshire, was to have workers do it themselves.

Team manager Melanie Birtchnell says: "Our multi-disciplinary practice reference group (PRG) was set up as part of our quality improvement agenda. It includes occupational therapists, social workers and case co-ordinators and it has been involved in projects such as developing assessment and care planning tools."

With support from two external consultants - Andy Foster and Jacquie Henley - the PRG turned to case file recording. Birtchnell says: "We knew our files needed work but we didn't have the tools to see where we were or to set benchmarks. Practitioners do spend a
lot of energy doing paperwork so it's better to spend that energy doing it right."

Foster says: "We managed the audit but it was carried out by members of the PRG because we felt there would be greater ownership of the process. The comprehensive audit tool, which has 120 areas of enquiry, was agreed on the fourth draft, which shows it was a collaborative process."

After the audit of 50 case files, the PRG, team managers and assistant team managers agreed an action plan from the audit report's recommendations. Case co-ordinator Anita Hawthorne says: "Staff weren't so anxious about changes because they knew that their colleagues had been involved."

Checking colleagues' files was a worry for some. Occupational therapist David Coast says: "I was thinking, 'Oh no, I'm going to be poking around my mate's file'. This seemed like bad news. But we were reassured and we were able to reassure our colleagues that there would be no repercussions. If there was a rubbish file you wouldn't get hauled up in front of the management".

Hawthorne adds: "It was also successful because our colleagues really supported us in allowing us to do the audit."

Anxieties apart, the audit itself proved an eye-opener. Senior practitioner, occupational health, Melanie Adcock says: "It was amazing how much duplication there was, and the amount of paper-chasing needed to get authorisation signatures from management - which reduced the time people spent with clients."

Coast adds: "I knew we needed to improve but I didn't know how much until we had to answer all the questions from the audit tool."
The audit found that a lack of time often prevented good work being recorded which, says Birtchnell, "didn't do the
worker justice".

However, Foster adds: "In reality if it's not evidenced on file it can only be assumed that it hasn't taken place." There were also difficulties in pulling out information from many files. "It was usually there and often in the contact sheets - but there could be about 50 of them," says Coast.

The process, says Hawthorne, also helped staff feel more empowered. She says: "I feel valued because the department listened when I said things, and I feel proud to have been involved. Even if I move jobs I will still have had a big input into designing this tool and so will have left a piece of me here."

LESSONS LEARNED

  • There will be greater staff ownership if staff are involved.  Hawthorne says: "People pay more attention to thins like that.  It's like if one of their own, as it can't be all that bad."
  • Build trust with staff.  Coast says: "I was apprehensive about the PRG at first and it took a few good meetings before we could trust management.  But once we could it was good for them to hear what we were saying."
  • It can lead to other things. Adcock says: "We've been thinking about making care plans more specific, alive and relevant to service users."
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