Quality assurance in an acute geriatric ward

A multi-disciplinary problem oriented patient record was introduced on to a 24-bed geriatric ward, replacing separate professional records. A Clinical Psychologist and Quality Assurance Consultants assisted with implementation. A Master Problem List with care plans consisting of goal setting and goal achievement analysis were used. Doctors justified use of medications and radiological investigations. Audit indicators were developed for completion of documentation, goal achievement, functional status at discharge, medication and radiology usage. Thirty four per cent of patients' records showed at least one goal not achieved and 45% not reached by review date. Twenty per cent of patients had lower functional status on discharge. Medication cost per patient fell by 10.8% compared with the year prior to introduction. On a similar ward, medication cost rose by 6.7%. This problem resolution approach helped to assure safer discharge and improved team communication. Prescribing behaviour was modified.