Record keeping | QCS

Record keeping

Dementia Care
July 17, 2017

What is the best way to record activity provision in a care home?

At NAPA we are often asked this question and, unfortunately, there isn’t a simple answer. Virtually every care setting that I have been in has a different way of doing it even across homes in the same provider group that have standardised paperwork.

I believe there are a number of key questions to answer before deciding on an appropriate format.

  1. What do we need to record and why?
  2. Who will do the recording?
  3. How should it impact on the care?
  4. How much time is available to do it?
  5. When will it be done?
  6. Will it be paper based or digital?
  7. Who needs access to it?
  8. Where will it be stored?

To ensure truly person centred care the team need to know what are the most meaningful activities for each resident. These can often be identified through conversations in the early days post admission. Asking a question like what do you want or need today that you had at home yesterday can throw up useful answers. For many, it will be simple things like getting the same newspaper that they’ve always had. For my father, living with dementia, it would have been a reporter’s notepad and stock of pencils to meet his need to sit and write out the alphabet for hours on end. This information can be recorded quite simply and I have often seen pages in care plans called something like Social Activities. I prefer to use language like Mary enjoys… Followed by a table or grid that details blocks of time in a day when they usually like to do these things. Many of us are creatures of habit. We build routines and rituals into our day without even thinking about it. When someone moves into care the care team take on a key role in replicating a person’s chosen usual day. Often the team don’t recognise or value the importance of these, commonly seeing activities as group events that people attend at fixed times in the day. If carers are expected to record how a person has spent their day in the Daily Notes it raises the importance of these activities. The regulator wants to see far more of this type of recording as it demonstrates a really person centred approach. A while ago an Inspector said to me “They recorded Pad Changed – surely they talked about something while they were there.” I know from experience that few carers get good training or support around the important topic of what to record which also drives what is seen as important.

Activities staff often keep separate records which I am not in favour of. It tends to increase the divide that can exist between carers and the activity leaders. If they all share the same information and capture useful details then the resident should benefit at the end of the day. It can also lead to duplicating which is not the best use of their precious time. One useful tool for the activity team is a log sheet laid out like a register that simply allows for a tick to show if a planned interaction has taken place. Spread over 7 days this can ensure that nobody gets missed out but it will not detail the outcome or benefits of an intervention.

NAPA has written a publication called A Guide to Activity Planning (£4.50) which has lots of useful information about planning and recording. This is available from the NAPA online shop at www.napa-activities.co.uk or call 0207 078 9375.

Sylvie Silver
Sylvie Silver

Activities Specialist

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