Triangulating Evidence in Dementia Care: Making Data Audit-Proof
Dementia services are increasingly judged on the credibility of their evidence, not the volume of it. Triangulation is the method that makes evidence audit-proof: comparing different sources to confirm what is happening and whether improvement is real. A strong outcomes, evidence and quality assurance approach sets the structure for triangulation, while alignment with dementia service models ensures that the evidence reflects real delivery and lived experience. This article explains how to triangulate evidence properly and use it to drive improvement.
What triangulation means in practice
Triangulation means testing one source of information against others, for example:
- Incident trends against care records and observation.
- Audit findings against staff competence evidence and supervision records.
- Family feedback against complaints themes and action logs.
This is essential in dementia services where outcomes are complex and changes can be subtle.
Why single-source evidence is risky
Single-source evidence creates blind spots. Examples include:
- High activity participation recorded, but low engagement observed.
- Training completed, but practice remains inconsistent.
- Low safeguarding referrals, but rising low-level concerns in daily notes.
Triangulation prevents false reassurance and strengthens learning.
Key evidence sources to triangulate in dementia services
A practical triangulation framework often uses five sources:
- Quantitative data: incidents, admissions, falls severity, medicines errors, staffing metrics.
- Qualitative feedback: family feedback, complaints, compliments, resident voice methods.
- Records review: care plans, daily notes, MCA documentation, risk assessments, reviews.
- Observation: practice observation, mealtime audits, interaction quality checks.
- Governance evidence: meeting minutes, action tracking, escalation logs, supervision records.
Operational example 1: Triangulating distress reduction evidence
Context: A service reported reduced distress episodes, but families felt evenings were still difficult.
Support approach: Leaders triangulated: distress incident logs, staff shift notes, and a structured evening observation audit.
Day-to-day delivery detail: Staff recorded time, triggers and recovery for distress episodes. Observers reviewed staff responses during evenings (tone, pacing, environmental noise, transitions). Families were invited to provide structured feedback about evening experience.
How effectiveness is evidenced: The service found that incidents reduced overall, but distress increased on weekends with higher agency usage. The improvement plan targeted weekend staffing stability and introduced a weekend routine guide. Follow-up data and observations demonstrated sustained improvement, and family feedback improved.
Operational example 2: Triangulating medication safety and competence
Context: MAR audits showed compliance, but minor medication errors continued.
Support approach: Leaders triangulated MAR audits with medicines incident reports, competency assessments and direct observation of medication rounds.
Day-to-day delivery detail: Competency assessments focused on dementia-related complexity: refusal, capacity, timing flexibility, PRN decision-making, and documentation. Observations checked interruption control, double-checks, and safe storage routines.
How effectiveness is evidenced: The service identified that errors clustered around interruptions and shift change. A “protected meds round” process was introduced, and supervisors coached staff on refusal documentation and escalation. Errors reduced and competence improved, evidenced through repeat observation and assessment outcomes.
Operational example 3: Triangulating restrictive practice reduction
Context: Leaders believed restrictions were minimal, but an external visitor noted several environmental restrictions (locked doors, removal of items, “quiet room” use).
Support approach: The service triangulated restriction logs, care plans, MCA/best interests documentation, and observation of the environment.
Day-to-day delivery detail: Staff reviewed each restriction: purpose, lawful basis, alternatives tried, and review dates. Leaders audited whether restrictions were recorded consistently and whether reduction plans existed.
How effectiveness is evidenced: Several restrictions were found to be “normalised” and not clearly reviewed. The service introduced a restrictive practice register, monthly reviews, and staff coaching on least restrictive approaches. Evidence showed improved review compliance and documented reduction actions, supported by observation and improved lived experience.
How to structure triangulation so it is repeatable
Triangulation should not rely on individual managers’ memory. Strong systems include:
- Scheduled triangulation reviews: monthly themed deep-dives (distress, falls, medicines, safeguarding).
- Clear templates: what sources are reviewed, what questions are asked, and how actions are recorded.
- Action tracking: ownership, deadlines, and re-testing dates.
- Learning loops: staff briefings, supervision follow-up, and policy updates where needed.
Commissioner expectation
Commissioners expect robust assurance that links evidence to improvement, including clear learning from incidents, transparent governance and defensible decision-making.
Regulator / inspector expectation (CQC)
CQC expects providers to demonstrate how they know care is safe and effective, using multiple evidence sources, and how learning leads to sustained improvement in people’s lived experience.
Why triangulation is a maturity marker
Triangulation demonstrates operational credibility. It shows the service is not simply reporting data, but understanding it, testing it, learning from it, and improving practice in a sustained way.