St. Louis Hospital Zonkwa has provided HIV care services to 1631 patients as at June 2012 of which 1024 were commenced on ART. Patients who are enrolled into HIV care are expected to be evaluated from ART, have routine clinic visits, scheduled labs and receive prophylaxis.
In March 2012, biannually performance measures showed that 29.1% of the 24 active adults in care had TB screening done at every clinical visit. The lack of the routine screenings increases their chances of contacting TB. The Quality team conducted a root cause analysis and discovered that once a patient Is enrolled into care and does not quality for ARVs, the patient does not get seen routinely with documented appointments and when they do come to the hospital they do not get assessed for TB/STI or received any prophylaxis.
The team agreed to try out the following strategies within a 3-month period
§ Ensure that all patients enrolled into care have documented appointments
§ Educate all care providers about the importance at every visit
§ Reminder to Doctor to document result of clinical TB screening; of the doctor forgets the nurses will document this once the patient comes for his next appointment
At the end of each month, the team reviewed the charts of all non-ART patients that had a clinic visit within the month excluding patients that were newly enrolled in the month. A zero was entered if the section for TB screening was left blank and 1 if a results (“TB suspect” or “non-TB suspect”) was documented. The results was collated and shared with the team.
We found out that a lot of the nonART patients were no longer active (no clinic appointment in the last 6 months) and they were terminated from care. Of the number that we found active in care, more than 80% of them had a documented TB screening during their visit.
In June we were unable to carry out the review to due to changes in the management of the team – the QI officer resigned.
This review provided an opportunity for the clinic to re-evaluate follow-up for non-ART patients and introduce systems that ensure that they get seen at regular intervals. Ensuring good medical documentation provides evidence for identify and understanding patient care among providers in the clinic.