Clinical Audit Uganda

Plot 2, Sturrock Road, Kololo, Opp Lohana Academy, PO Box 8045, Kampala, Uganda | [email protected] Clinical Audit Uganda - Innovative training improves quality of care Christine Tibamanya, a widowed mother intravenous quinine in stock at the time of of the health service. It took into account of five walked into the Hoima regional the survey . the Ugandan context benchmarked referral hospital out patients department against national and international severe carrying her three year old third born child Severe malaria case management was malaria case management standards. Turinawe, He was febrile and lethargic. A characterized by limited or incomplete lower health unit near her home 15KM patient history, poor differential The clinical audit approach also away had referred her to Hoima hospital diagnosis of other causes of fever, long recognized that existing quality for an emergency blood transfusion since waiting hours for critically ill patients, lack improvement strategies such as Turinawe was severely anemic. That was 15 of adequate space for close monitoring of continued professional development hrs ago. severely ill patients, and oriented workshops for health workers in inappropriate administration of the health service delivery setting were Her previous experiences with Hoima Intravenous fluids by health workers. largely ineffective and limited in their regional referral hospital was a crowded capacity to holistically identify, analyze Out Patients Department that was It’s against this background that the Clover and address factors that undermine characterized by delays, jostling for project together with the aforementioned quality health care delivery. positions in the line to be attended to by partners designed and developed a a doctor. It was a first come first serve basis strategy aimed at improving the quality A total of seventeen health facilities were with no priority made for the severely sick, of care for severe malaria case selected based on their capacity to admit particularly children. management in selected Clover patients – district hospitals, regional supported district health facilities. This referral hospitals and health centre IVs. This time, however, to her surprise, an intervention is the clinical audit approach. Each facility then identified health workers attentive nursing aide immediately pulled from the different departments to her aside from the waiting line, briefly Clinical audit a tool for improving constitute a health facility clinical audit examined Turinawe before weighing him standards of medical care. Health care committee thereby ensuring and registering his vital signs into a professionals measure clinical performance representation of managerial and register. She then escorted them and effectiveness to ensure that the best administrative positions. personally into the physician’s room; in all available treatment is given to patients at it took less than 15 minutes. all times. Clinical audit is a quality Over 415 health workers were provided improvement process that seeks to hands-on training with bedside teaching, So how did this transformation come improve patient care and outcomes complemented by four rounds of on site about? Clover - Malaria Consortium through systematic review of care against clinical audit/severe malaria support together with doctors from the national explicit criteria and the implementation of supervision from central supervisors in each referral hospital – Mulago, and the change. Aspects of the structure, of the health facilities. Ministry of Health technical working group processes, and outcomes of care are on malaria case management under took selected and systematically evaluated a cross sectional survey of 11 Clover against explicit criteria. Where indicated, supported districts to identify severe changes are implemented at, individual, malaria clinical practices. The survey team, or service level and further covered 105 health facilities; in total 181 monitoring is used to confirm improvement health workers and 879 patients and/or in healthcare delivery. care takers were interviewed. The survey observed that only 44% of those health A clinical audit operational frame work facilities surveyed had established and and guidelines manual was developed functional triage systems in place and through an exhaustive consensus only 11.4% of health facilities had separate building approach with partners from queues in the outpatient departments for clinical, administrative and managerial Health facility clinical audit action plan adults and children, and only 54.5% had positions involved in the whole continuum –Hoima Regional Referral hospital Out Patients Department for more information please contact CALL +256 31 2 300 420 | www.malariaconsortium.org Plot 2, Sturrock Road, Kololo, Opp Lohana Academy, PO Box 8045, Kampala, Uganda | [email protected] Health facility clinical audit committees sat requests and malaria slides that are Based on experiences and lessons on a quarterly basis over an eight month colored RED by the prescribing physician. learned from, the National Malaria period. In total thirty interactive meetings Control Programme prioritized clinical were held by health facility clinical audit audits in its Global Fund Round 10 committees. These exercises involved proposal. It is also working closely with in-house monthly reviews of severe Stop Malaria – a USAID funded project malaria practices through root cause anal- implementing the approach in 12 districts ysis designed to identify gaps, and with the intention to scale it up to 14 weakness and through consensus, more districts during 2011. develop practical, specific and time bound action points to address the challenges therein. Performances were benchmarked against standards highlighted in the previous meetings. A sample bottle of 500mls 5% Dextrose solution with multiple doses of quinine Within eight months of implementation using plasters to improvise timelines for of clinical audits, significant changes had medicine administration in a child of four been observed in the quality of severe years. malaria case management, specifically with the intravenous administration of Illustration of multiple dosing of intrave- quinine which was previously given in Previously very sick patients were not nous quinine in 500ml 5% dextrose multiple doses over shorter periods of triaged. Health workers had little solution. Note attendant in the back- time. understanding of this concept and many ground responsible for supervising the very sick patients spent a long time in flow rates. Waiting times for severely sick patients the waiting lines. However with the com- especially children significantly reduced prehensive training that clinical audits Soon after admission, Turinamwe was since there was a concerted effort by provided to health workers with regards given a blood transfusion and his blood to severe malaria management, our staff health workers to triage them now have the capacity to identify very smear was quickly processed. It was found immediately. Inpatient wards were sick patients and triage them for quick to contain malaria parasites and he was re-organized to ensure that special rooms/ emergency care”. administered intravenous quinine beds/space was available for severely ill Dr Musinguzi Patrick, Malaria Zonal appropriately. Christine and Turinawe will patients for close monitoring. Laboratories Coordinator and Physician Hoima soon be able to go home and spend were tasked to prioritize blood transfusion Regional Referral Hospital. time with the rest of their family. for more information please contact CALL +256 31 2 300 420 | www.malariaconsortium.org.

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