By Faustine Ngarambe & Ntale Jonathan St. Francis Health Care Services, Njeru

Transcription

1 Reducing Number of newly registered clients who miss CD4 screening By Faustine Ngarambe & Ntale Jonathan St. Francis Health Care Services, Njeru Academic Supervisor: Rudolf Buga Dissemination workshop Hotel Africana, 14/8/09 1

2 Institution Background Initiated in 1998 as an AIDS service organization. Services in the districts of Mukono, Jinja and Kayunga. Holistic services: HIV counseling and testing: Sero-prevalence of 14.5% Management of opportunistic infections & ART Home-Based care services Livelihood support for OVC and Grannies Child mentoring programme Registered 9,000 clients (7,500) 2

3 Scale Up of Clinical Care and ART Programme 2005 ART delivery with support from JCRC (out-reach) 2007: St. Francis is accredited by MoH as an ART centre : MoU signed with Inter-religious Council of Uganda (IRCU) to Scale up ART services on Site. May 2008: ART Services on site. 3

4 Problem Identification/ Prioritisation Staff meeting was held Problems identified using client flow diagram Multi-Voting on the most hindering issues Theme selection matrix used to prioritize the issues identified. 4

5 THEME SELECTION MATRIX RESULTS Theme Customers Impact on external customer s No qualified triage personnel at reception to take records Clinician doesn t know the last CD4 date for non-eligible ART clients. OPD, ART, and Non- ART Non-ART. clinician, counselors Need to improv e Overall rating 5, SCALE OF IMPORTANCE Fair Quite Big Bigger Biggest 5

6 STAFF BRIEFING ON CQI PROGRAMME CQI TEAM MEETING MEMBERS MULTI VOTING MEMBERS BEING INSTRUCTED ON MULTI VOTING PROCEDURE 6

7 Problem Statement Between June and August 2008, 49% of the newly registered clients missed CD4 screens for A.R.T at St. Francis Health care Services hence interfering with possible early initiation of patients onto A.R.T by clinician. Improvement target: to reduce number of missed CD4 screens from 49% to 5% in 4 months 7

8 Analysis of the Baseline Situation Bar chart showing clients who missed cd4 screening prior to implementation of CQI project GRAPH SHOWING PERCENTAGE VARIATION OF MISSING CD4s y = e 1.138x R² = PERCENTAGE OF MISSING CD4, JULY, 40 PERCENTAGE OF MISSING CD4 Expon. (PERCENTAGE OF MISSING CD4) PERCENTAGE OF MISSING CD4, JUNE, 10 8

9 Project Objectives Broad objective: To reduce the proportion of clients who miss CD4 counts. To improve the CD4 count data records To improve the triage system To develop and disseminate Client identity cards to ease personal file retrieval 9

10 Tasks Procure equipment for id development Re-register all clients into computer & provision of identity cards to them Management meeting to revise job descriptions for the triage staff General staff meeting for dissemination of guidelines on client flow protocol Recruited a qualified staff to head the triage Organized refresher training for all staff on health communication and the client flow 10

11 Results 1: Revised Client flow RECEP TION TRIAGE (CD4 TAKEN) YES USER FEE WAITING/ HEALTH TALK COUNS ELING CLINICAL EXAMINA TION NO LAB TESTS (CD4) YES NEED TESTS? COUNS ELLING END NO DISPENS ER 11

12 Result 2 PERCENTAGE OF MISSING CD4s BEFORE AND AFTER IMPLENTATION OF CQI PROJECT % OF MISSING CD4S, AUGUST, 97 P E R C E N T A G E % OF MISSING CD4S, JUNE, 10 % OF MISSING CD4S, JULY, 40 % OF MISSING CD4S, SEPTEMBER, 20 % OF MISSING CD4S, OCTOBER, 8 JUNE JULY % OF MISSING % OF MISSING CD4S, NOVEMBER, 13 BEGINING AUGUSTOF IMPLEMENTAT SEPTEMBER ON OCTOBER NOVEMBER DECEMBER JANUARY CD4S, DECEMBER, 10 % OF MISSING CD4S, JANUARY, 5 12

13 Result 3 Identity cards made and distributed Pie char showing ratio of clients photographed in 3 months To the total number of clients visits 3 13

14 NUMBER OF CLIENTS Result 4: Increase in clientele registered and CD4 screening 4 No. NEWLY REGISTERED Total No. CD4 SCREENED MONTHS 14

15 Lessons Learnt When people understand the benefits of change, they are likely not to resist change Team work motivates individuals to accomplish tasks 15

16 Challenges 1. Lack of efficient antivirus software countered by setting up data back ups to prevent loss of data use of internet antivirus helped to clean up the system 2. Insufficient follow- up supervision by academic supervisor Used the manual Phone calls and s to the coordinator 16

17 Sustainability Plan Continued computerized client registration continuation of ID development Management employed a permanent receptionist 17

18 Recommendations TO SPH-CDC HIV/AIDS FELLOWSHIP PROGRAM Joint support supervision by SPH facilitators and alumni fellows TO ST. FRANCIS HEALTHCARE SERVICES Incorporation of the CQI cycle into the planning programs of the organization besides ART 18

19 To staff of St. Francis Acknowledgements Support of SPH academic team; supervisor and coordinator CDC for financial support 19

20 THANK YOU FOR LISTENING 20