IMPROVING TRACKING OF CLIENTS MEDICAL CHARTS AT AN HIV CLINIC TASO JINJA

Transcription

1 IMPROVING TRACKING OF CLIENTS MEDICAL CHARTS AT AN HIV CLINIC TASO JINJA Fellows: Dr. Josephine Birungi & Sophie Nantume TASO Uganda Academic Mentor : Dr. Ellie Rutebemberwa Institutional mentor :Dr. Nkoyooyo Abdallah Dissemination workshop 7 th Oct Imperial Royale, Kampala

2 TASO Background The AIDS Support Organization (TASO) is an NGO providing counseling, treatment and care, antiretroviral therapy to HIV positive persons and social support to OVC household. It operates HIV clinics in 11 districts of Uganda, one international Training Centre with the Headquarters in Mulago.

3 TASO Jinja Area of CQI project implementation Is situated in the South Eastern region, 80km from Kampala. It serves a clientele of over 7000 HIV +ve persons of which 3500 clients on ART.

4 Problem Identification & Prioritization After training in Continuous Quality Improvement (CQI) at the SPH, the fellows visited TASO Jinja, HIV clinic During the meeting, staff weree sensitized about CQI principles and asked to identify challenges they faced in service delivery that they perceived to be affecting the quality of services offered. Each staff wrote this on a piece of paper.

5 Problem Identification & Prioritization (Results of problems identified n=42 staff) 15% 3% Missing files Long waiting time 24% 58% Appointment system not working as expected Poor time Management

6 What was this problem called Missing file/medical Chart? TASO Jinja HIV clinic receives between 200 to 300 clients on each of the clinic days as per appointment. Each client has a medical chart received in the past. with records of services The problem was that sometimes clients reported for services and unfortunately their medical charts were reported missing/ misplaced which led to long waiting time, frustrations, treatment on loose forms and difficulty in review of clients concerns on previous visit.

7 CQI team formation The staff members secondedd the existing HIVQUAL team to work on this project together with the CQI fellows however a Records clerk was co opted to this team The fellows and the CQI team then developed a work plan for the project following the CQI process/steps

8 Baseline situation In October 2010, 03 clinic days were sampled to establish the magnitude of Missing medical charts. The attendance on each of the clinic day was about 3000 clients. Approximately 12.6% that is 37 medical charts were reported missing/misplaced on each of the clinic days. The performance audit report showed that data entry was taking up to 7 days from the time of service delivery a diversion from the SOP that recommends 48 hours Medical charts returned to records room 7 days after service delivery and instead 48 hours as indicated in the SOPs

9 Objectives General To improve tracking of clients medical charts at HIV clinic TASO Jinja Specific objectives To reduce the percentage of medical charts reported missing on every clinic day from 12.6% to 3% by March To reduce the time the medical chart spends outside the storage/records room from 7 days to 3 day after the provision of the service

10 Cause &effect analysis Using the fish bone

11 Counter measures Problem Root Cause Counter Measure Practical Method Missing Medical Charts 1. Delayed data entry 2. Medical charts not being in the storage at the right time Scale up supervision data entry clerks of Workload analysis Conduct work load assessment Develop a file tracking Develop file request form system and data capture screen Emphasis use of SOPs & A meeting to remind staff of importance of returning the SOPs for managements files on time to staff records Ensuring that no medical charts are stored in staff offices A meeting with the Supervisor ( IMO) Weekly check up of staff offices to pick redundant medical charts 3. Clients not keeping Sensitize clients about keeping appointments Conduct health talks about keeping appointment

12 Training of the CQI team

13 Monitoring & supervision of the project Project was being monitored at two levels; The HIVQUAL team leader was the overall seer of the project implementation at center CQI fellows would regularly visit to monitor progress of the project implementation and to offer technical support to the team. A total of 4 follow up visits were made. There was support supervision by the mentors

14 Support Supervision Photo: CQI fellow (Dr. Birungi), CQI team member (Carol Wanyana Records Clerk, TASO Jinja) and the Mentor (Dr.Ellie from MakSPH ) in the Storage/Record room at TASO Jinja

15 Project outcomes No.of missing medical charts % of missing medical charts (n=300) Baseline Jan Feb Mar Apr May June July Months

16 Outcome (2) Time taken to return Medical charts on storage room (days)

17 Outcome (3) Time taken to enter data (Hours)

18 Lessons Learned Staff need to be reminded of SOPs from time and again Team work is a very importantt aspect in medical records management Application of CQI processes/principle can solve many problems in service delivery with minimal resources Management buy in is a key success factor.

19 challenges CQI team members had set organizational targets to achieve and at first perceived this as an additional work load Fellows were required to respond to many urgent activities whichh some times clashed with the planned support supervision visits

20 Way forward Support the TASO Jinja CQI team to work towards 0% missing medical charts at the clinic Replicate it in other TASO HIV clinics to solve any challenges affecting quality of service Provide training in Continuous Quality Improvement (CQI) to middle level Managers Ensure that all staff utilize and follow the Quality assurance manual

21 Acknowledgement Clients TASO Jinja CQI team and staff TASO senior management Mentors: Dr. Ellie & Dr. Nkoyooyo CDC/MakSPH fellowship team Development Partners CDC

22 Thank you for Listening