QUALITY IMPROVEMENT EOPD QI PROJECTS.pptx

QIP

1. Health care Quality Improvement Project PROJECT TITLE፡ TO Decrease EOPD Attendance Length of stay > 24hrs from 3% to < 1 % Starting From Sane 21,2015 EFY - uptake Hidar 20, 2016 EFY . REGION: Oromia,North Shoa,Chancho HEALTH FACILITY: Chancho Primary Hospital DATE : 21/10/2015 E.C

2. EOPD Quality Improvement Team Members: S. No Name(s) Department Profession Responsibility 1 Dr. Mulugeta Faye EOPD Cordinator GP Chair person 2 Mr. Naol Gelelcha EOPD Head Nurse Secretary 3 Dr.Gezahany Damana MD GP Member 4 Mr.Chala Ligaba Matron Nurse Member 5 Mr.Amensisa Melka QU Head Nurse Member 6 Sr.Ayantu Buta Emergency Triage Focal Nurse Member 7 Mr.Abebe Hambisa EOPD Nurse Member

3. Background information about health facility Chancho Hospital is a primary Hospital located 40 km from capital city A.A in the northern direction Started serving the community by June 15, 2008 E.C. Serving total of more than 283,873 population in the catchment area Have 10HCs and 23HPs under the PHL Surrounded by Road

4. Organization’s Mission, Vision, Scope of Service Vision To see healthy, productive and prosperous community of our catchment Goal To have Service Provider based initiative Health Policy

5. Mission To Reduce morbidity, mortality, disability and improve the health status of catchment population through provision of quality curative and rehabilitative health services, and bring comprehensive package of prevention closely to community of our catchment”

6. Outlines Back ground Problem identification and prioritization Problem statement Team`s Aim statement Fish bone diagram Driver diagram Change Ideas Measures/ Indicators PDSA Test Implementation done Lesson Learned Aknowlegdement

7. Problem identification and prioritization Matrix SN Lists of problems identified Prioritization criteria Rank magnitude Feasibility Importance Total 1 Low patient record completeness 3 4 3 10 6 2 High > 24hrs EOPD attendance 5 5 5 15 1 3 Low EOPD Triage performance 3 4 4 11 5 4 High EOPD referral Out 4 4 4 12 4 5 Low infection prevention 4 5 4 13 3 6 Low pain Management 4 5 5 14 2 Grade minimum – 1 ,Maximum -5

8. Problem statement (prioritized for improvement ) For the last Nine Months from Meskerm 2015 E.C- Ginbot 2015 E.C EOPD attendance >24 hrs was 3% that leads to poor quality of care ,low patient satisfaction, low outcome & low bed occupancy rate to our Hospital .

9. Team’s Aim Statement (SMART) We C hancho primary Hospital EOPD QI team aim To Decrease EOPD attendance length of stay > 24hrs from 3% to < 1 % Strating from Sane 21,2015 EFY - Uptake from Hidar 20, 2016 EFY .

10. Lack of social worker Shortage of emergency drugs Interrupt emergency triage Morning session Poor documentation Delayed patient registrat ion Lack of oxygen cylinder Poor patient monitoring and follow up Delay to decide timely Poor commitment Lack of ECC trained nurse/physician Poor interdepartmental cordination Delayed investigation result Poor documentation Lack of guidline and protocol Adherence Lack of commitment Lack Affordability Low socioeconomic status Lack awareness High >24 hour EOPD Attendance Provider FISHBONE DIAGRAM Facility Process Data Leadership Community

11. Driver Diagram To Derease EOPD length of stay from 3 % to <1 % from sane 21/2015 EFY to Hid 20, 2016 EFY Leadership and Facility Process Provider Delayed investigation result Poor interdepartmental cordination Lack of oxygen cylinder&interrupt emmergency triage Lack of medical equipment and emergency drugs Lack of adherence protocol and guideline Delayed patient registrat ion&poor documentation Lackof Affordability& socoio economic problem Lack of Emergency &critical care trained HCP delayed timely decision & low commitment SMART Aim Strengthing interdepertmental cordination Proper pts monitoring and document follow up Conduct Community forum and health promotion conduct timely decision and staff motivation Timely collection of investigation results & avail emergency labiratory Primary Drivers Secondary Drivers Change Ideas Add additional Oxygen cylinder &re-establish emergency triage Establish socal service unit and trained person Conduct regular clinical audit on protocol and guidline adherence Give onsite staff training on emergency and critical care &peer to peeer skill transfer Data community Lack of social worker Supply emergency equipment and emergency drugs Pts lack of awareness and delayed decision estabilsh social unit&support Start morning session No morning session

12. List of Interventions/Change ideas Strengthing interdepertmental cordination Add additional Oxygen cylinder &re-establish emergency triage Establish socal service unit and trained person Supply emergency equipment and emergency drugs Conduct Timely collection of investigation results & avail emergency laboratory Conduct regular clinical audit on protocol and guideline adherence Properly patient monitoring and document follow up Conduct Community forum and health promotion Give onsite staff training on emergency and critical care &peer to peeer skill transfer Conduct timely decision and staff motivation Conduct morning session

13. Measuring Indicators Outcome Measure: % EOPD attendance length of stay > 24Hrs Process Measure #of Strengthing interdepertmental cordination # of Add Additional Oxygen cylinder &re-establish emergency triage # of Establish socal service unit and trained person # of conduct Timely collection of investigation results & avail emergency laboratory # of Conduct regular clinical audit on protocol and guideline adherence # of Conduct Community forum and health promotion # of Give onsite staff training on emergency and critical care &peer to peeer skill transfer # of Conduct timely decision person and staff motivation # of conduct morning session # of Supply emergency equipment and emergency drugs

14. Measures/Indicators Aim Outcome measure Change ideas Process measures Balancing measures Indicator Numerator Denominator Data Source To Decrease EOPD attendance length of stay > 24hrs from 3% to < 1 % Strating from Sane 21,2015 EFY - Uptake from Hidar 20, 2016 EFY . Indicator EOPD attendance >24HRS Strengthing interdepertmental cordinatio n % of strengthing interdepartmental cordination # of interdepartmental cordination strengthens Total no of planned interdepartmental cordinated EOPD Minutes numerator No of attendants who stayed >24hrs at EOPD Conduct community forum& Health promotion % of conduct community forum & Health promotion given # of community forum conducted & Health promotion Given Total No of community forum conducted & Health promotion planned CPH minute Denimonator Total no of patients seen at EOPD Add Additional Oxygen cylinder &re-establish emergency triage % of Add Additional Oxygen cylinder &re-establish emergency triage # of Additional Oxygen cylinder add& emergency triage estabilshed day Total no of Additional Oxygen cylinder add& emergency triage estabilshed day EOPD Biomedical Data source EOPD registration conduct Timely collection of investigation results & avail emergency laboratory %of conduct Timely collection of investigation results & avail emergency laboratory # of investigation result timely collection conducted &avail time of emergency laboratory # total no plann of investigation result timely collection conducted &avail time of emergency laborato ry CPH , Laboratory To conduct regular clinical audit& avail protocol and guideline % of clinical audit conducted & avail protocol and guideline # of clinical audit conducted&availed protocol and guideline Total No of clinical audit planned to be conducted & availed protocol and guideline QU Clinical Audit team EBC commite Give onsite staff training on emergency and critical care &peer to peeer skill transfer % of Give onsite staff training on emergency and critical care &peer to peeer skill transfer # of staff Onsite trained on ECC&peer to peer skill transfer Total no of staff Onsite trained on ECC plann &peer to peer skill transfer

15. Cont…. Measures/Indicators Aim Outcome measure Change ideas Process measures Balancing measures Indicator Numerator Denominator Data Source Indicator EOPD attendance >24HRS Conduct timely decision person and staff motivation %of Conduct timely decision person and staff motivation # of decision person timely conducted& motivate staff Total no of planned decision person timely conducted& motivate staff EOPD cordinator SMT minute numerator No of attendants who stayed >24hrs at EOPD conduct morning session % of conduct morning session # of morning session conducted Total no of day planned morning session conducted CCO Denimonator Total no of patients seen at EOPD Establish socal service unit and trained person % of Establish socal service unit and trained person # Of social service unit estabilished &trained person Total no Of social service unit estabilished &trained person Social service CPH Data source Supply emergency equipment and emergency drugs % Supply emergency equipment and emergency drugs # of emergency equipment &emergency drugs supply Total no of plan emergency equipment &emergency drugs supply Store

16. P of PDSA S N o . What (Change ideas) Process Measure Where ( service area) Who (responsible body) When (timetable ) How Start date End date 1 Strengthing interdepertmental cordinatio n % of strengthing interdepartmental cordination EOPD Dr,Gezahany Naol Sane Hamle BY morning session 2 Conduct community forum& Health promotion % of conduct community forum & Health promotion given CPH Tamirat Dr.Gezahany Qaurter 1 3 Add Additional Oxygen cylinder &re-establish emergency triage % of Add Additional Oxygen cylinder &re-establish emergency triage CPH , Biomedical Tamirat Dabala Sane Hidar 4 conduct Timely collection of investigation results & avail emergency laboratory %of conduct Timely collection of investigation results & avail emergency laboratory CPH LAB Dr.Gezahany Hurisa Sane Tik 5 conduct regular clinical audit& avail protocol and guideline % of clinical audit conducted & avail protocol and guideline QU Clinical audit Team Amensisa Chala Naol Sane Hidar Audit by two weeks 6 Give onsite staff training on emergency and critical care &peer to peeer skill transfer % of Give onsite staff training on emergency and critical care &peer to peeer skill transfer QU Capacity building commite Amensisa Fikadu Dabala Hamle mesk 7 Conduct timely decision person and staff motivation %of Conduct timely By decision person and staff motivation EOPD CPH Tamirat Dr.Gezahany Dr.Mulugeta Sane Hidar

17. Cont… P of PDSA S N o . What (Change ideas) Process Measure Where ( service area) Who (responsible body) When (timetable ) How Start date End date 8 conduct morning session % of conduct morning session All Department Dr,Gezahany Sane Hidar By weeks 2 day 9 Establish socal service unit and trained person % of Establish socal service unit and trained person CPH Social service Unit Tamirat Dr.Gezahany Diro Nahase Tik 10 Supply emergency equipment and emergency drugs %Supply emergency equipment and emergency drugs Store Hirut Sane Hidar

18. P of PDSA… Outcome measurement data collection plan AIM Data source (Where) Data collection method (how) Time (When) Responsible for DC To Decrease EOPD attendance length of stay > 24hrs from 3% to < 1 % Strating from Sane 21,2015 EFY - Uptake from Hidar 20, 2016 EFY . DHIS2 EOPD Registration By Auditing Observation report& EOPD Registration Bi two weeks Naol Tashoma Ethiopia Amensisa

19. P of PDSA S.N Process/Change idea Data source (Where) Data collection method (how) Time (When) Responsible Person 1 strengthing interdepartmental cordination EOPD Minute By two weeks Dr.Gezahany,Chala 2 conduct community forum & Health promotion given CPH Observation minute,client interview Quarterly Tamirat,Gezahany 3 Add Additional Oxygen cylinder &re-establish emergency triage EOPD,Biomedical observation By two weeks Dabala,naol , chala 4 conduct Timely collection of investigation results & avail emergency laboratory EOPD,LAB Observation, interview Daily Hurisa,Naol 5 clinical audit conducted & avail protocol and guideline QU Clinical Audit Monthly Amensisa 6 Give onsite staff training on emergency and critical care &peer to peeer skill transfer EOPD Obsevation Minute Quarterly Dr.Mulugeta,DR.Daba 7 Conduct timely By decision person and staff motivation CPH,EOPD Staff interview, By two weeks Dr.Gezahany,Chala 8 conduct morning session Morning session Minute Observation, interiew staff Every one weeks Dr.Gezahany,Chala 9 Establish socal service unit and trained person CPH,Social unit Audit,observation Monthly Diro,Dereje , 10 Supply emergency equipment and emergency drugs Store Observation,interview Bi two weeks Hirut,Dareje

20. Outcome measurement Aim Numerator ,denominator and outcome indicator SANE HAM NAH MESK TIK Hid To Decrease EOPD attendance length of stay > 24hrs from 3% to < 1 % Strating from Sane 21,2015 EFY - Uptake from Hidar 20, 2016 EFY No of attendants who stayed >24hrs at EOPD 14 5 10 5 3 3 Total no of patients seen at EOPD 627 580 489 611 559 639 % of EOPD attendance >24HRS 2.2 0.8 2 0.8 0.5 0.4 20

21. HOSPITAALA CAANCHOO / CHANCHO HOSPITAL Runchart of EOPD length of stay > 24hrs 3% to <1 uptake From Sane 2015 EFY –Hid 2016 EFY Timely Decision & commitment Re Establish Emergency Triage&pre Triage Avail EmergenyLab & Emergency Drugs Onsite Training & peer to peer skill Transfer Interrupt oxygen supply Baseline median Baseline Data before QI project After QI project

22. Do Refreshment Tea program prepared and orientation given for EOPD Nurses on appropriate patient follow up and day to day peer to peer registration review and communicate with physician for timely decision

23. Act We adopt/adapted focused on Eopd length of stayto reduce with integrated provider and client. Next implementation progress will be regular clinical audit ,give feedback on performance

24. Lesson learned awareness creation For client the advantage of admission Staff orientation and goal directed focusing will strengthen team sprit Staff motivation is manadatory to reduce length of stay Physician/Nurses are integrated with decrease length of stay at EOPD

25. Strength Administrative attention is good to improve EOPD on project success. EOPD staff commitment on continuously evaluate registration. Internal support suppervission is conducted

26. Weakness/Gabs Interrupte water at EOPD room Social service problem Shortage of human power trained Shortage of room at EOPD

27. Acknowledge Chancho Hospital EOPD Staff ORHB Quality office Chancho Hospital QU and PMT . Chancho Hospital HMIS Department

28. THANK YOU