PERSON CENTRED HIV PATIENT MONITORING AND CASE SURVEILLANCE

Transcription

1 ONSOLIT UILINS ON PRSON NTR IV PTINT MONITORIN N S SURVILLN NNX PTINT MONITORIN SYSTMS SSSSMNT KLIST JUN 2017

2 1 nnex Patient monitoring systems assessment checklist (adapted from existing [unpublished] document) This simple assessment should be adapted to the setting and carried out at the beginning of each annual patient monitoring review visit. The checklist provides a quick review of the presence and quality of: integrated systems and national tools; human resource capacity; efficient patient and data flow; and accurate and complete data collection, transfer and reporting. ach sub-checklist is followed by a list of recommended actions that should be carried out immediately by the review team. The review team should then outline the follow-up plan, including action needed at the national level or on subsequent site visits. final overall assessment will indicate whether or not the facility can feasibly carry out the remainder of the PMR. o you have the necessary patient monitoring elements in place? Tick ( ) the YS box if the statement describes your health centre. If not, tick NO. NO items need to be implemented or improved. If not applicable, tick N/. Integrated systems 1 YS NO N/ re the patient monitoring systems for IV, MN/IV and T/IV integrated? a I J K L N/PMTT re some or all of the IV patient monitoring tools used in the MN setting? List all. re some or all of the T patient monitoring tools used in the MN setting? List all. o the following MN patient monitoring tools include IV elements? N/Maternal health card N register Labour record L& register hild health card Other (specify) Is there a separate/different patient record for IV-exposed infants? Is there an IV-exposed infant or mother infant pair register? Is the IV-exposed infant or mother infant pair register linked to the N register or RT register entries for the mother? T/IV re some or all of the IV patient monitoring tools used in the T clinic? List all. a Integration may also include to some extent other programmes, including hepatitis, noncommunicable diseases (Ns) such as hypertension, diabetes and others. dapt as appropriate.

3 2 onsolidated guidelines on person-centred IV patient monitoring and case surveillance M N re some or all of the T patient monitoring tools used in the IV setting? List all. o the T patient monitoring tools include IV elements (T treatment card and registers)? List all. omments. Recommended action. If one or more relevant staff are not trained on one or more of the different components of the patient monitoring system, the district team should schedule and provide these staff with appropriate training or retraining, followed by hands-on support within 2-4 weeks. IV uman resources 1 YS NO N/ ll relevant staff in IV clinic have received appropriate training on the national patient monitoring system within past X months: octors, clinical officers ow many? ard Registers Reports ata use Nurses, nurse assistants ow many? ard Registers Reports ata use ata clerks ow many? ard Registers Reports ata use Lay counsellors ow many? ard Registers Reports ata use Other, specify: ard Registers Reports ata use re the relevant IV staff trained in the use of the T patient monitoring tools? Who Tools omments.

4 nnex Recommended action. If one or more relevant staff are not trained on one or more of the different components of the patient monitoring system, the district team should schedule and provide these staff with appropriate training or retraining, followed by hands-on support within 2 4 weeks. 2 YS NO N/ The following national patient monitoring tools are available in adequate supply (may insert T and MN tools as relevant): omments. Patient-held card IV patient card ommunity RT monitoring tool RT register ross-sectional report RT cohort analysis report ppointment book Transfer/Referral form Recommended action. If one or more of the tools is absent or in short supply, the district team should ensure adequate supply by copying or providing new forms to the facility. nsure that the facility team has recently received the necessary training in patient monitoring. 3 YS NO N/ Use of patient monitoring tools List tools and state reason for use. The facility is using the national patient monitoring tools. The facility is using additional or other tools than the national patient monitoring tools.

5 4 onsolidated guidelines on person-centred IV patient monitoring and case surveillance omments. Recommended action. If the health centre is using something other than the national tools, the district management team should ensure that the correct tools and accompanying training are provided. If facilities are using these tools due to a lack in the national system, this should be noted by the district team and reported to the Mo for follow up. There may be additional tools and forms implemented by non-mo institutions or donors supporting the facility. The district team should ensure that these have been authorized by the Mo and that there is no duplication with the national tools. In as much as possible, the use of additional tools should be minimized. 4 YS NO N/ Organization and storage of patient monitoring tools omments. IV patient cards and RT registers well-organized and stored in secure location Unique patient I generated in systematic way according to national standards and provided to each patient enrolled in IV care Recommended action. If records are not well organized, identify reason: lack of space, lack of storage structure, not organized by patient I or other efficient means. nsure adequate space, shelving or filing cabinets and orderly organization of records. If records are not secure, ensure that there is a locked cabinet or office where they can be stored, with limited access to storage. 5 YS NO N/ Patient and data flow are well defined and efficient omments. IV patient cards are pulled from storage for all patients to be seen at start of day IV patient cards follow patients and are completed as they go through care IV patient cards are returned to registration after each visit, and stored

6 nnex Recommended action. If data flow does not correspond to patient flow (i.e. lab tests, clinical care, counselling points, or drug pick-up are not updated in patient record) or if cards do not follow patients, discuss with facility team to understand patient and data flow. Together, outline recommendations and detail steps to be taken on how to improve process, and ensure patient information is complete (e.g. drug pick-up, not just drug prescription, is recorded on patient card). Use flow diagrams if necessary. 6 Take a sample of 5 IV patient cards and check for the following: YS NO N/ IV patient card is complete and accurately filled out IV patient card has been started for all patients enrolled in IV care and/or on RT I J K L M N O P YS NO N/ Summary page Sociodemographic information is complete amily status box is complete as relevant IV care summary box is complete Prior RVs box is complete RT care box is complete as relevant RT treatment interruptions box is complete as relevant ollow-up status box is complete YS NO N/ ncounter page One row is completed for each visit T status is filled in at each visit Weight is filled in at each visit Pregnancy status is filled at each visit if woman of childbearing age If infant <59 months, age in months, weight gain ± oedema, mid-upper arm circumference (MU) and nutritional problems recorded YS NO N/ ducation and support page Regular comments and dates filled in as appropriate by health worker YS NO N/ PMTT considerations IV-exposed infant follow-up box is updated on mother s IV patient card IV-exposed infants who have been confirmed positive have their own IV patient card and line in the RT register

7 6 onsolidated guidelines on person-centred IV patient monitoring and case surveillance omments. Recommended action. In general, if information is incomplete or inaccurate, go directly to the source of where that information should have come from. or example, the sociodemographic information is generally filled out by the registration clerk or nurse, whereas most of the encounter page is filled out by the doctor or clinician. Talk to the responsible health worker about the gap or error, and discuss the reasons why. If the health worker did not receive the appropriate training, or was inadequately trained, follow recommended action in section 1. If the health worker knows how to fill in the information but was too busy or simply forgot, explain the importance of complete information for patient care, and for data transfer to the registers later on. lag the health worker for subsequent visits to ensure that she/he is correctly filling in the information. 8 YS NO N/ RT register find register entries for a sample of IV patient cards I J K L omments. RT register(s) are filled in following start of RT and updated with each patient visit. olumns are complete using standardized coding. ontact information complete with unique I T treatment, TX prophylaxis, T preventive therapy, V/V screening completed as relevant Pregnancy columns updated if relevant Patients organized by start date of RT, months do not overlap on page Transfer in patients recorded below line under those starting in original clinic by RT start date aseline status at start RT and changes in regimen with reasons and dates recorded. Make sure changes match right-hand side Standard codes in each column are used for current drug regimen or patient status in top row urrent breastfeeding or pregnancy codes filled as relevant in bottom row Months labelled at top of columns 4 count if available recorded at 6, 12, 18, 24 months and yearly thereafter VL if available recorded at 6, 12 months and yearly thereafter

8 nnex Recommended action. If information is missing or incorrectly filled in, talk to the responsible health worker about the gap or error, and discuss the reasons for them. If the health worker did not receive the appropriate training, or was inadequately trained, follow recommended action in section 1. If the health worker knows how to fill in the information but was too busy or simply forgot, explain the importance of complete information for patient care, and for tallying data from the registers for the cross-sectional and RT cohort reports later on. lag the health worker for subsequent visits to ensure that she/he is correctly filling in the information. 9 YS NO N/ ross-sectional report I J omments. ross-sectional reporting forms completed and sent up or collected on timely basis ll cells filled in Tallies add up Table 1 New and cumulative started on RT by sex and age complete Subset of those started on RT complete (pregnant/breastfeeding females, baseline 4/4 200, active T disease, started on T preventive therapy, screened for hep /) Table 2 urrent on RT by first-, second- and third-line RVs, sex and age complete Subset of those current on RT complete (T treatment started, VL results recorded, VL suppressed) Table 3 N information complete Table 4 L& information complete Table 5 I information complete Recommended action. If cells are not complete, or inaccurately tallied, go to source, work with health worker to review and enforce understanding. If health worker did not receive the appropriate training, or was inadequately trained, follow recommended action in section 1. If reports are consistently late, consider reasons why and problem-solve with health workers to ensure timely reporting.

9 8 onsolidated guidelines on person-centred IV patient monitoring and case surveillance 10 YS NO N/ Validate the RT cohort report by using the RT registers and re tallying the columns omments. RT registers are tallied to complete RT cohort reports and sent up or collected with the supervision of district management team regularly. ll columns filled for cohorts completing baseline, 6, 12, 24 months up until present ractions recorded where relevant Tallies add up VL used to track status of adult patients Recommended action. The RT cohort report requires validation from the district team during facility visits even if it is filled out by the facility. This can be coupled with the annual patient monitoring review activity. If the facility is unable to fill out the RT cohort report, it is the job of the district team to do so. This can be done every 6 12 months during site visits. copy of the report should remain at the site for the health workers to review the progress of their patients on RT. If cells are not complete, or inaccurately tallied, go to source, work with health worker to review and enforce understanding. If the health worker did not receive the appropriate training, or was inadequately trained, follow recommended action in section 1. If reports are consistently late, consider reasons why and problem-solve with health workers to ensure timely reporting. 11 YS NO N/ ppointment system omments. ppointment book or system used to log patients next visit, prepare clinic day for expected patients, identify missed appointments; and follow up with those missing appointments Patient and treatment supporter contact information updated and complete ates for LT recorded on summary forms Recommended action. It is important for health workers to know when patients miss appointments and to follow up as necessary. The health facility must therefore have a simple yet functioning appointment and follow-up system. If none exists, see examples provided. simple appointment book, one page for each day can be used, or a tickler file system.

10 nnex YS NO N/ Transfer/Referral system omments. Standard transfer forms are used to receive and transfer out patients ealth centres abide by national transfer protocol when transferring and receiving transfer patients Recommended action. very health facility should abide by the national, standardized transfer or referral system in place. This includes the transfer of key information such as that given on the front of the patient card to the receiving facility in order that continuous care and treatment are provided to the patient. If no transfer protocol exists, a minimum of key information should be transferred with the patient, including sociodemographic characteristics and summary of treatment (as on front page of IV patient card). 13 YS NO N/ ata use omments. ealth workers have regular meetings to review patients charts or for case management review ealth workers understand how to use information on the patient card to manage patient care and treatment ealth workers understand how to use registers to help follow-up status of patients care and treatment ealth workers understand how to use cross-sectional reports for planning purposes as relevant ealth workers understand how to use RT cohort analysis reports to identify patient outcomes and follow up accordingly Recommended action. In addition to being able to accurately complete all patient monitoring tools, health workers should be able to use the information collected and reported to inform both patient management and programme monitoring at the facility. ach piece of information that is collected, and each indicator that is compiled and measured is done for a reason. ata use should be carried out on a regular basis and should be a routine part of quality care and treatment. Quality assurance activities may also be carried out by reviewing some of the data collected. Regular site visits by the district management team and clinical mentors can

11 10 onsolidated guidelines on person-centred IV patient monitoring and case surveillance support data use among health workers. ealth workers should understand that using data is as important as filling, entering and reporting it. N/PMTT uman resources 1 YS NO N/ ll relevant staff in M clinics have received appropriate training on the national patient monitoring system within past X months: octors, clinical officers ow many? ard Registers Reports ata use Nurses, nurse assistants ow many? ard Registers Reports ata use ata clerks ow many? ard Registers Reports ata use Lay counsellors ow many? ard Registers Reports ata use Other, specify: ard Registers Reports ata use re the relevant MN staff trained in the use of the IV patient monitoring tools? Who Tools omments. Recommended action. If one or more relevant staff are not trained on one or more of the different components of the patient monitoring system, the district team should schedule and provide these staff with appropriate training or retraining, followed by hands-on support within 2 4 weeks.

12 nnex Tools 1 YS NO N/ oes the maternal health card have the following IV elements: ate enrolled in IV care and unique I number Infant-feeding intention and practice RV adherence counselling and reporting IV test date, result(s) and whether result(s) received Malaria intermittent preventive therapy (IPT) doses RT start date RV regimen and date dispensed during pregnancy, L& and postpartum I TX started J T preventive therapy/t treatment started K Infant RVs given during delivery and dispensed postpartum 2 YS NO N/ oes the N register have the following IV elements: IV status at admission IV test date, result(s) and whether result(s) received Partner tested Maternal unique I number Maternal RT start date Maternal RV regimen and date dispensed during pregnancy Intermittent preventive therapy (IPT) doses T status 3 YS NO N/ oes the labour record have the following IV elements: Maternal RT start date Maternal RV regimen and date dispensed during labour Infant-feeding counselling and practice 4 YS NO N/ oes the postpartum record have the following IV elements: Maternal RT start date Maternal RV regimen and date dispensed postpartum Infant IV testing Infant RV prophylaxis Maternal and infant RV adherence Infant TX prophylaxis

13 12 onsolidated guidelines on person-centred IV patient monitoring and case surveillance Infant T test result and prophylaxis Infant-feeding practice 5 YS NO N/ oes the L& register have the following IV elements: IV status at admission and previous test date Maternal IV test date and result Maternal RT start date Maternal RV regimen and date dispensed during labour Infant RVs received Infant-feeding practice Intended family planning method chosen T status 6 YS NO N/ oes the child health card have the following IV elements: I J K L Maternal IV status ate and time of birth Newborn and infant-feeding practice Infant-feeding counselling and support Maternal RT start date Infant RVs given, date and duration Infant RV adherence Infant IV test type and result TX provided Infant confirmed IV-infected ate infant enrolled in IV care/rt and unique I number T status 7 YS NO N/ oes the IV-exposed infant register (or mother infant pair register) have the following IV elements: ate of delivery (or estimated due date) IV-exposed infant registration number Maternal unique I number Infant name Maternal RT start date Maternal RT at 3, 12 months postpartum Infant RV prophylaxis taken and duration Infant-feeding practice within 24 hours of when last seen at 3 months (or TP3 visit)

14 nnex I J K L M N Infant age started TX Infant IV test date, age, type and results ate infant enrolled in IV care/rt and unique I number Infant RT start date Infant T status Infant final status T/IV uman resources 1 YS NO N/ ll relevant staff in T clinics have received appropriate training on the national patient monitoring system within past X months: octors, clinical officers ow many? ard Registers Reports ata use Nurses, nurse assistants ow many? ard Registers Reports ata use ata clerks ow many? ard Registers Reports ata use Lay counsellors ow many? ard Registers Reports ata use Other, specify: ard Registers Reports ata use re the relevant IV staff trained in the use of the T patient monitoring tools? Who Tools Who re the relevant M staff trained in the use of the T patient monitoring tools? Tools omments.

15 14 onsolidated guidelines on person-centred IV patient monitoring and case surveillance Recommended action. If one or more relevant staff are not trained on one or more of the different components of the patient monitoring system, the district team should schedule and provide these staff with appropriate training or retraining, followed by hands-on support within 2 4 weeks. Tools 1 YS NO N/ oes the T monitoring system have the following IV elements: IV test date and results. If no, list tools: PT start. If no, list tools: RT start. If no, list tools: RV regimen date and dose dispensed. If no, list tools: Unique I. If no, list tools: 4 date sent and results. If no, list tools: VL date sent and results. If no, list tools: N number. If no, list tools: omments. inal action plan o NOT proceed with the PMR if any one of the following outcomes was found during the initial assessment: 1. The IV patient card (or an equivalent) is not being used at all. OR 2. The RT registers are not being filled out at all. OR list other relevant setting-specific conditions. O proceed with the PMR if: list relevant setting-specific conditions.