Team approach to the problem-oriented record in a long-term care facility.

Abstract

At the Extended Care Unit of the Health Sciences Centre Hospital at the University of British Columbia, team participation in the care of 300 elderly patients includes the team's ability to facilitate use of the problem-oriented record (POR). The key to making the POR a functional communication tool was the development of a useful Problem List. In establishing this system, many difficulties arose. It was imperative to recognize that many staff members had not been trained in problem-solving techniques, and that they had varying degrees of knowledge about the data base. Active physician involvement was mandatory. Employment of a half-time POR Coordinator working with a supporting interdisciplinary POR Committee was needed to make the system work. Guidelines for defining problems were developed, and Problem Lists gradually acquired significance for the entire health care team. Examples are included. Concurrent continuing education was started in pathophysiology, problem-solving, and use of the POR.