Recurring concern
Failure to review relevant clinical records before care decisions
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Request correctionFirst reported 23 Aug 2013•Latest report 8 Jun 2026
What this concern includes
Includes failures to consult, check, cross-reference or review relevant existing clinical records as part of clinical assessment, prescribing, treatment, admission, transfer, escalation or other care decisions, including review of the correct record set and routine review requirements.
Not included
- Excludes failures to retrieve or make records available when the records were not accessible in the first place; those belong to access or record-availability concerns.
- Excludes deficiencies in the completeness, accuracy or maintenance of the records themselves unless the asserted unsafe condition is also failure to review them.
- Excludes generic failures to communicate or hand over clinical information where no record-review failure is identified.
- Excludes non-clinical record reviews, such as administrative, inspection or mortuary monitoring records.
- Reports
- 54
- Individual concerns
- 59
- Date range
- 2013–2026
- Stated actions
- 70
Distinct published reports
A report can raise multiple concerns
First to latest report issue date
Described in published responses
Reports over time
Reports over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
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Concerns raised1
Failure to review clinical notes during ward transfer and overnight review
This report raised 11 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
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Concerns raised1
Failure to routinely consult patients' records
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
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Action
Inform staff of named- and associate-nurse responsibilities for knowing service-user care plans and current circumstances.
Stated by Sheffield Health Partnership University NHS Foundation Trust
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Concerns raised1
Failure of hospital staff to regularly read clinical and nursing entries in patient medical records
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3
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Action
Write to all consultants reiterating expectations to read clinical and nursing notes written by trainees and other staff.
Stated by Oxleas NHS Foundation Trust -
Action
Conducted a follow-up inspection of Oxleas NHS Foundation Trust’s acute wards to assess whether specific improvements had been made.
Stated by Care Quality Commission -
Action
Return to inspect Oxleas NHS Foundation Trust and follow up the identified concerns to check that necessary improvements have been made.
Stated by Care Quality Commission
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
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Position
Specific circumstances of Julia MacPherson’s individual care and treatment fall outside the regulator’s remit for comment.
Stated by Care Quality Commission
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Concerns raised1
Failure to consult the correct set of medical notes
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
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Concerns raised1
Failure to review relevant historical mental health records
This report raised 6 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
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Action
Reinforce comprehensive clinical-record review, including the risk assessment, before staff see patients.
Stated by North London NHS Foundation Trust -
Action
Check clinical-history review practice during regular staff supervision.
Stated by North London NHS Foundation Trust
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Concerns raised1
Failure to consult or cross-reference the Summary Care Record when prescribing
This report raised 7 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
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Concerns raised1
Failure to consider relevant previous medical record entries in subsequent patient care
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
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Action
Provide ward-based education, updates and reminders supporting professional responsibility for patient care and contemporaneous recordkeeping.
Stated by Blackpool Teaching Hospitals NHS Foundation Trust
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Concerns raised1
Failure to review relevant clinical records during MDT meetings
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
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Concerns raised1
Failure to review available records fully during assessment
This report raised 8 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
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Concerns raised1
Failure to review details of earlier calls when assessing subsequent calls
This report raised 8 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
Data last updated 7 September 2026