Post on 12-Jan-2016
transcript
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Dr Abdelhaleem BellaConsultant Pulmonologist
Deciphering the Quality Jargon
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Time for Quotation
Why this presentation
The asthmatic who landed back in acute severe attack after discharge?
• We are seeking accreditation in KFHU• MSc Healthcare Nov 2012• Done it before (AFHSR)• We should be doing it since : decree since
October 2011
Merriam Webster
1. : peculiar and essential character
2. : capacity3. : degree of excellence4. : superiority in kind5. : social status6. : a distinguishing attribute
http://www.merriam-webster.com/dictionary/quality
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Question Time (1)
What do these mean :
1. JCI2. FOCUS3. PDCA4. OPPE5. Audit
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FOCUS
F• Find opportunities for Improvement
O• Organize a team that knows the process
C
• Clarify the Current knowledge of the process
U
• Understand the source of improvement
S• Select the desired outcome
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PDCA
OPPE & FPPE
FPPE and OPPE are professional practice evaluations which are determined by your medical staff for confirming competency (focused) and for more routine monitoring of all practitioners in a specialty (ongoing)
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Do we know what we are doing in KFHU?
Question Time(2) General Medicine: How many hypertensive patients
achieved their targets and had all the necessary investigations done?
Pulmonary : Do all asthmatic follow the SINA/GINA guidelines?
Cardiovascular: How many patients with atrial fibrillation follow guidelines?
GIT: Do we treat H Pylori right? Hepatology: Are all patients on interferon for Hepatitis
C in need of it? Renal: How many patients had renal biopsy who
needed to have them I.D: Do we follow hand hygiene as suggested by WHO? Rheumatology: How do we give the anti-TNF Oncology: what do we know about chemotherapy
induced toxicity in KFHU?
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How do we know what we are doing in KFHU?
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We need to do audit!
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Audit in KSA
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Personal Experience: AFHSR
TB Audit
61 results availableAge range 5 month-94 yearsM 34 F 27MTB 36 NTM 25NO MDR isolatedMonoresistance in MTB :HNTM commonly Resistant to first
line Anti TB
22 file reviews
Of All 61 medical notes requested only 22 were available for review
No One Had documented tuberculin skin test
No one had documented notification
Outcome documented in 9 onlySide effects of Medications: 1
hyperuricemia, 1 gout, 2 hepatitis (mild)
Mycobacterium Isolates
26, 43%
35, 57%
NTM
MTB
• NTM isolated: SIMIAE (6) Fortuitum(3) Abscessus (3) and Others
• Samples sent from different Areas.
• There are Cost implications as culture used to be sent to Bioscientia
Documentation of AntiTB treatment
18, 82%
4, 18%
Medication used documented
NO
• It is required that the anti TB medications used ,their doses ,start and end day of treatment to be documented
PMH of Treated TB
4, 18%
18, 82%
treated TB before
No
• 18% of this group of patients had treated TB before which is higher the international numbers and may reflect failure of previous treatment or re-infection from an un-assessed contact
Problems identified
No clinical registry available to access information (Preventive Med, HIPE, even the lab request forms were incomplete)
File retrieval through Medical records department had been difficult
Medical Notes incomplete ,uninformative most of the time
Outcome documentation lackingLab analysis of samples shows a high
percentage of NTM which may reflect contamination and wasted resources
Proposals for Improvement
Tuberculosis team and clinic ( to improve documentation, notification, follow up of patients )
Introduction of HIPE system to facilitate any future data retrieval .
Support of the TB service with local TB culture and identification methods( reduce contamination ,reduce delay)
Re Audit the TB service after 6-12 Months
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Current Status
4 months after the audit work started in TB Clinic Clinic run by : Physician (Pulmonary & ID),
Preventive Medicine Registrar, Tb Nurse Weekly Clinic All patients are seen by the in-charge physician
and checked by preventive medicine staff for notification and screening of contact
Lab technicians assigned for the TB data and contact of physicians
Data manager appointed and all information available
Defaulters are contacted and followed up Regular report sent to MOH Research: Epidemiological data , other work
suggested
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Clinical Audit: a Primer
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In 1858 things started to change
Clinical Governance
Clinical Governance is a quality assurance process designed to ensure that standards of care are maintained and improved and that the NHS is accountable to the public.
"A framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish."
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Types of Clinical Audit
1.Standards based Audit2.Adverse occurrence screening
& Critical incident monitoring3.Peer Review4.Patient surveys and focus
group
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Audit Cycle
Audit vs Research
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Features of Effective Audit
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Points to consider when doing an audit
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University Hospital Bristol Audit team
Semi qualitative online survey Trainees in UK 2267 Audits by 504 43% completed one cycle Challenges: Training , results not
shared ,incomplete , absence of senior physicians in audit meetings, etc
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A more detailed cycle!!!
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British Thoracic Society Audit
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50% Discount from the CME Committee: Projects for grab!!!!!
HypertensionAsthma
Atrial Fibrillation
Hepatitis C
Renal Biopsy
Hand HygieneAnti-TNF
Chemotherapy Induced toxicity
Auditing the Audit
References
In your mailbox I mean the email!