PARTNERSHIP FOR HIV FREE SURVIVAL HEALTH FACILITY COACHING GUIDE: SECOND VISIT (JUNE 2013) BRIEFLY INTRODUCE ASSIST PROJECT AND TEAM

Transcription

1 PARTNERSHIP FOR HIV FREE SURVIVAL HEALTH FACILITY COACHING GUIDE: SECOND VISIT (JUNE 2013) BRIEFLY INTRODUCE ASSIST PROJECT AND TEAM The Ministry of Health with financial support from the United States Agency for International Development (USAID) has been implementing Quality of Care Initiative in HIV/AIDS since November 2005 with support from the USAID Health Care Improvement (HCI) project. In 2012, a follow on project to HCI called USAID ASSIST (Applying Science to Strengthen and Improve Systems) was awarded to work with and support the Ministry of Health and USG partners to improve the quality of care in HIV/AIDS care and treatment, PMTCT (including the Partnership for HIV Free Survival), SMC, HTC, and HIV TB, OVC, integrating FP into HIV and MNCH. INTRODUCTION TO THE PARTNERSHIP FOR HIV FREE SURVIVAL (PHFS) To support the Ministry of Health goal of elimination of new HIV infections among children by 2015 and Keeping their Mothers Alive, PEPFAR and other technical partners are supporting national efforts to develop and scale up an effective campaign to provide optimal nutrition for infants and to protect those infants from HIV infection. Together, the effectiveness of antiretroviral drugs (ARV) to reduce HIV transmission and the benefit of breastfeeding to reduce deaths due to malnutrition, diarrhoea and pneumonia represent an exceptional opportunity to improve HIV free survival of infants born to HIV infected mothers. Using quality improvement (QI) methods, the PHFS will support existing country specific protocols and the ongoing Nutrition Assessment Counseling and Support (NACS) activities to achieve 4 essential steps of postnatal mother infant care that results in excellent nutritional and HIV care for both the HIV exposed and nonexposed infants over the first 24 months of life. WHAT IS THE COACH EXPECTED TO ACHIEVE DURING AND AFTER THIS VISIT? Follow up on the action plans made from the previous visits: has the team made any changes to improve retention and data quality? Collect retention data for May 2013 Teach and assess for core Quality Improvement activities at each visit (these will be discussed and agreed upon prior to each coaching visit) Review data completion and accuracy for all the relevant details and support the team to come up with ideas for improving this Review the previous action plans and report to determine what changes were (or were not) implemented; determine specific progress and results made with regards to integrating nutrition into HIV/AIDS services; review site level data with the team, and develop a specific action plan to address how to improve results. WHAT PREPARATION IS NEEDED PRIOR TO A COACHING VISIT? Prior to the coaching visit the coaches should: 1. Contact the site QI teams and agree on a date and time for the coaching visit (each coaching visit will take a maximum of 3 hours) 2. Review the site s previously agreed action plan and focus on this for the visit 3. Before you meet with the site teams, pay a courtesy visit to the DHO and brief them about the purpose of the visit and share any progress 4. At the site, meet with Medical Superintendent or In Charge of the health facility, share purpose, schedule, duration and expected outcomes of visit. USAID ASSIST Project PHFS Health Facility Coaching Guide: Second Visit Page 1 of 10

2 SECTION 1. GENERAL INFORMATION Site Name, District and Region: Date: / / QI Coaches: No. Name Type of coach(central, Regional, District) Telephone Names of site personnel attending meeting with coaches: Surname Other Names Job Title Responsibility at the facility Telephone E: mail NB: Responsibility at the facility e.g., in charge, counselor, triage nurse, clinician, dispenser, laboratory work, PMTCT nurse etc. USAID ASSIST Project PHFS Health Facility Coaching Guide: Second Visit Page 2 of 10

3 SECTION 2: DATA ON AREAS OF FOCUS There are two areas of focus for improvement which we would like the QI teams to get started on first. Before the training and coaching session begins the coach should collect baseline data on the following areas: Focus Area 1: Retention of mother baby pairs in care Collect the numerator for the retention of mother baby pairs in care in May 2013 The numerator is: The number of mother baby pairs who kept their appointments for May. To get this numerator: Use the Exposed Infant Diagnosis (EID) appointment book which gives you the number of exposed infants who kept their appointments in May Find the ART number of the exposed infant s mother from the EID care card or EID register and trace her ART card to see if she received ART care at the same visit). Fill this information in the tables below Outcomes for the period of 1 st Sept 2011 to April 30th st, 2013 Tally Total Number Comment Number of infants who kept their appointments for May 2013 (EID appointment book) Number of mothers of the infants in (H) who got ART in May (look for mother s ART number and then check in the ART register or ART care card) Number of newly enrolled infants onto the EID register in April 13 EID infants who died in April 2013 EID infants discharged positive in April 2013 EID infants discharged negative in April 2013 EID infants transferred out in April 2013 The numerator is : I (mothers who received ART care and have babies in EID) USAID ASSIST Project PHFS Health Facility Coaching Guide: Second Visit Page 3 of 10

4 Focus Area 2: Completeness and Accuracy of Data You will need to collect baseline data on the completeness of data tools as well as check on the accuracy of this data if possible. The main data tools are the EID care cards, EID register and the EID appointment book. The EID care card will be used to measure completeness of data as follows: Using the sampling strategy attached in the appendix Take the total number of cards seen in May. Look for that number in the column of Total Eligible population in sampling tool and see the corresponding minimum number of cases sampled (N) Divide this number (N) by the minimum number of cases to be sampled to get the sampling interval Sample those cards by picking every other card as per sampling interval until you get the total number to be sampled Check each of the selected cards to see that all the parameters on the cards have been filled for the last patient visit The numerator for this indicator is: The number of sampled cards with completely filled parameters The denominator is: The total number of cards sampled Please insert this information in the table below Number of cards sampled with completely filled out parameters Total number of cards sampled Check the EID register and see whether the data is accurate and the register is completely and correctly filled. Make any observations below:.. SECTION 3: TRAIN TEAMS HOW TO USE THE DATA TOOLS Train the team on the how to fill the EID registers, EID appointment book and EID care card. You could ask one of the team members who already knows how to use these tools to lead this exercise. Note any observations below. SECTION 4: KEY QI COMPETENCIES Quality Improvement team members need to have the knowledge, skills and attitudes to carry out particular Quality Improvement activities. There are 4 key QI activities that the coach must train the team in: I. Root cause analysis (problem identification) using the following QI tools the cause effect diagram, fishbone, process mapping, brainstorming II. III. Designing an improvement project Use of data for QI and the documentation journal Refer to the slides in the appendix for each of these areas; you will need to repeat this exercise with the District Quality Improvement team USAID ASSIST Project PHFS Health Facility Coaching Guide: Second Visit Page 4 of 10

5 SECTION 5: COACH THE QI TEAM IN THE FOLLOWING AREAS: QI team functionality and composition I. Review team functionality using the attached Team Maturity Index to score the level at which the team is II. Team Composition Review the composition of the QI team, were any new members added, did any members leave? What are the roles and responsibilities on the QI team? Fill out the table below Name of Team Members (New) or Team Member with change in Status Role and responsibility on the QI team (team leader, secretary, member) Position in the health facility (e.g. N.O, M.0, Lab, PMTCT FP) New to Team? Y/N Left Team? (Use one of these: Inactive; Formally Resigned; Other ) III. IV. Check on the progress that the sites have made since the last coaching visits. Has the QI team identified a quality gap for which changes are being implemented? [ ] Y [ ] N USAID ASSIST Project PHFS Health Facility Coaching Guide: Second Visit Page 5 of 10

6 V. What changes did the sites test to improve a) Retention of mother baby pairs b) Improvement of data quality Is data on the addressed gap regularly collected? [ ] Y [ ] N If No, what are the challenges with data collection and what has the team done to overcome them? 5.2 Review of team s previous work plan and implementation Review the team s previous work plan if one was made and the progress made so far in implementing activities. NO PLANNED ACTIVITY IMPLEMENTED (Y/N) COMMENTS USAID ASSIST Project PHFS Health Facility Coaching Guide: Second Visit Page 6 of 10

7 5.3 Story Board (10 minutes) Review or discuss any stories about EMTCT service integration this month Choose 2 people to tell the story of what they did. [Rotate who tells the story at coaching visits.] These could be normal or problematic. Ask them to talk about all the PMTCT service delivery steps and how they worked. Coaches should be listening for appropriate steps and to determine if there are any problems. Take a few notes below. Briefly describe what happened and how this is different from what the clinic did before. [Ask them about the different service delivery steps, what is new, how they know their actions helped the client.] Take a few notes including name, approximate date and place where this occurred. USAID ASSIST Project PHFS Health Facility Coaching Guide: Second Visit Page 7 of 10

8 6. USING THE DOCUMENTATION JOURNAL: You will have to show the team how to fill documentation journals for the two improvement aims (Retention of mother baby pairs in care and data completeness). Each team must have two journals. Go through each component of the journal. 7. SHARING CHANGES: Share some of the following changes with the teams and agree on when and how they will be implemented. (Subsequently you will be provided with a change package for retention and improvement of data and you will guide the site teams to make a choice on what changes they would like to improve). Suggested changes are, but not limited to: Use of the column in the Early Infant Diagnosis (EID) appointment book to capture information on mothers who kept appointments ( divide the last column in the appointment book in 2; one column is ticked if the baby keeps their appointment and the other column is ticked if the mother picks her ART. Keep mother and child s care cards together Offer services at the MCH service point for both mother and baby instead of serving mother in ART and child in EID/MCH Give the same appointment dates for each mother baby pair (each pair must be seen monthly) Strengthening the linkage between Young Child Care (YCC) and MCH services so that all exposed infants in YCC are linked into care USAID ASSIST Project PHFS Health Facility Coaching Guide: Second Visit Page 8 of 10

9 8. ACTION PLAN Develop an action plan for the current/ next month (Specify the month planned for ).. ACTION PLAN Quality Gap to addressed Activity No 1 Person Responsible Time Frame USAID ASSIST Project PHFS Health Facility Coaching Guide: Second Visit Page 9 of 10

10 9. APPENDIX Sampling strategy Sampling Strategy (to be used to sample EID care cards to measure completeness of data Table 1: Determining Sample Size* Total Eligible Population Up to or more 150 * Based on sample size with 95% confidence interval Minimum # of Cases Sampled All USAID ASSIST Project PHFS Health Facility Coaching Guide: Second Visit Page 10 of 10