Where the same fact is asked twice
Each row is one underlying fact about a resident. Each column is a document that asks for it. Nothing here is a judgment about the forms — individually they are all reasonable. The problem only appears when you lay them side by side.
Identity is re-written about twenty times
| Field | Appears on | Documents |
|---|---|---|
| Resident's name | Every document — header of nearly every page | 9 |
| NHI number | Every document | 9 |
| Date of birth | E5, ATP, Dietary Profile, CS 14B | 4 |
| Date of admission | E5, E7, CS 13A, Dietary Profile | 4 |
| Room / unit | E5, Breakfast Order, Dietary Profile | 3 |
| Preferred name | E7 | 1 |
| Ethnicity | Dietary Profile | 1 |
None of this is clinical work. It is a nurse writing Margaret Wilson and an NHI number onto a twentieth line, with a transcription risk attached to each one.
The duplication matrix
Sorted by how many documents ask for each fact.
| Fact about the resident | E7 | CS 13A | CS 19C | CS 22A | Dietary | Breakfast | CS 14B | ATP | OR 10A | Asked on |
|---|---|---|---|---|---|---|---|---|---|---|
| Mobility / transfers Asked on five documents. | ○ | ○ | ● | ○ | ○ | 5 | ||||
| Nutrition / diet type | ○ | ○ | ● | ○ | 4 | |||||
| Skin / wounds / pressure | ○ | ○ | ● | ○ | 4 | |||||
| Food preferences Breakfast Order is a subset of the Dietary Profile. | ○ | ○ | ● | 3 | ||||||
| Swallowing / texture | ○ | ○ | ○ | 3 | ||||||
| Weight / BMI / loss | ○ | ○ | ○ | 3 | ||||||
| Continence E7's block is close to a subset of all of CS 13A. | ● | ● | ○ | 3 | ||||||
| Falls risk and history | ○ | ○ | ○ | 3 | ||||||
| Cognition / memory | ○ | ○ | ○ | 3 | ||||||
| Sensory — hearing, vision | ○ | ○ | ○ | 3 | ||||||
| Social and family support | ○ | ○ | ○ | 3 | ||||||
| Cultural / religious | ○ | ○ | ○ | 3 | ||||||
| Hygiene / grooming | ○ | ○ | ○ | 3 | ||||||
| Mobility aids, glasses, hearing aids | ○ | ○ | ○ | 3 | ||||||
| Beverage preferences | ○ | ○ | 2 | |||||||
| Allergies | ● | ● | 2 | |||||||
| Pain | ○ | ○ | 2 | |||||||
| Communication ability | ○ | ○ | 2 | |||||||
| Respiratory | ○ | ○ | 2 | |||||||
| Sleep pattern | ○ | ○ | 2 | |||||||
| Medication reconciliation | ● | ○ | 2 | |||||||
| EPOA | ● | 1 |
documents ask about mobility
E7, CS 13A, CS 19C, CS 22A and CS 14B. Four of them are asking so they can restate what CS 19C already establishes properly.
documents touch nutrition and food
Including the Breakfast Order, whose nine cereal options are reproduced exactly on the Dietary Profile.
forms cover continence
E7's continence block is close to a subset of the whole of CS 13A — the shorter one adds nothing the longer one misses.
CS 14B can largely calculate itself
Robinson's Resident Acuity Assessment scores fourteen domains from one to five, adds them up, and bands the total to a staffing classification. Twelve of those fourteen domains are already captured elsewhere in the pack.
Green — derivable from data already entered. Grey — requires fresh clinical judgment.
| Band | Total | RN hours / week |
|---|---|---|
| A | 14–20 | 1 hour Ambulant — clinically stable |
| B | 21–27 | 1–2 hours Low to medium dependency |
| C | 28–35 | 2–3.5 hours Medium dependency |
| D | 36–43 | 4–9 hours High dependency — unstable |
| E | 44–52 | 9–13 hours Hospital level — RN at all times |
| F | 53–70 | 14 hours Hospital level — RN at all times |
Why this one matters most
Today a nurse reads five documents, hand-scores fourteen domains, adds them up, and looks the total up against a band. The arithmetic and the banding are not clinical decisions — they are calculation, done by hand, at the end of a long admission, which is exactly when arithmetic errors happen.
And the output is not paperwork. It is indicative registered nurse hours per week. This is the one place where getting the intake right shows up directly in staffing and funding.
To be clear about what we are not proposing. The nurse still reviews and can override every domain. Complexity of needs and level of risk stay entirely with the registered nurse — they are judgments, not lookups. What disappears is the reading, the copying and the adding up.