QUALITY IMPROVEMENT INITIATIVES ON MEDICAL DOCUMENTATION IN 16 AIDSRelief PARTNER FACILITIES: SUCCESSES AND CHALLENGES
AIDSRelief consortium (AR) supports health facilities in Nigeria to rapidly scale up and deliver life-saving antiretroviral therapy. With challenges impeding best outcomes, AR continually identifies for improvement, factors influencing treatment success . AR strengthens structures that provide solutions to challenges patients face while accessing treatment.
The work was done across 16 AIDSRelief hospitals as listed below. The units were HIV/AIDS Care Units and the Staff were Doctors, Nurses, Laboratory Scientists, Monitoring and Evaluation Officers, Pharmacists and Auxiliary Health Workers.
Acknowledgements: Staff and Management of the 16 Hospitals:
1. Bishop Murray Medical Centre, Makurdi, Benue State
2. St Mary’s Hospital Okpoga, Benue State
3. St Vincent’s Hospital Aliade, Benue State
4. St Anthony’s Zaki Biam, Benue State
5. Faith Alive Foundation Jos, Plateau State
6. St Camillus Hospital Uromi, Edo State
7. St Catherine’s Hospital, Iwaro Oka, Ondo State
8. Holy Rosary Hospital Onitsha, Anambra State
9. Mother of Christ Specialist Hospital, Enugu, Enugu State
10. Annunciation Specialist hospital, Emene, Enugu State
11. St Monicas, Adikpo, Benue State
12. St Thomas Ihugh, Benue State
13. St Josephs Adazi, Anambra State
14. St Patricks Hospital Mile 4 Abakiliki, Ebonyi State
15. Our Lady of Lourdes Hospital Ihiala Anambra State
16. Faith Mediplex Hospital Benin, Edo State
Dysfunction – Poor Documentation
STEPS FOR IMPLEMENTATION
We reviewed 10 CQI indicators on medical documentation initially and then some months later; for 16 facilities between 2008 and 2009.
Hospital staff were engaged & sensitized on CQI concepts relating to Medical Documentation - they had periodic technical assistance visits where didactic sessions and hands on training were done; with periodic review of selected indicators on medical documentation; collection of feedback on performance and suggestions on the way forward, improvement planning and continuous review with the aim of achieving the standard for documentation as part of quality of care.
CHAMPIONS AND RESOURCES NEEDED
QI Resource Persons – trained and experienced QI Specialists who provide routine support to the facilities
Facility Based QI Focal Persons – trained hospital staff who ensure compliance at the facilities with respect to the indicators
Training Sessions & Materials – Site based didactic Sessions on Quality Improvement & Medical Documentation, Regional and National Trainings on the same topics as well as training manuals, review checklists & Standard Operating Procedure manuals.
Tools for evaluation – abstraction tools
Focus Group Discussions – these sessions look at improving clinic flow, medical record documentation and the quality of information that goes into the Patient Management forms. It’s an open discussion between hospital staff, the Site QI team and the QI Resource Persons.
Essentially used repeated abstractions and reviews to ascertain the effects of planned changes
Microsoft Excel was used in analysis of results for patterns and distributions
Solutions have to be site specific
Staff at sites have the ability to develop innovative strategies for solving problems
Rewards improve performance
Support has to be more regular to result in substantial improvement
Do differently next time:
Don’t set site plans in stone
Ensure early management understanding and Buy In
Attempt to focus capacity building efforts on staff that show potential for long term stay at the facility
Messages for others:
MAIN MESSAGE: Quality Improvement techniques can work in Resource limited settings and produce favourable results
Improved care and attention to detail, leading to concise documentation of findings provides the foundation for improved outcomes as a result of sound clinical decisions
Technical Assistance is important and necessary but has to be focused, tailored to facility needs and regular