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Transcript
QUALITY
IMPROVEMENT
Need
Identification
NEED ID AND
PROBLEM
STATEMENT
At Stellenbosch Hospital (SH) it became evident that patients testing for Covid-19 were not adhering to the self-isolation guidelines set up by the government.
This is a major risk for rapid transmission of the virus. We used the current circumstances of an impending peak in infection along with decreased resources to our advantage in order to get this project implemented in a timely manner.
Fishbone
Context
Context
Patients seen at SH come from various cultural backgrounds, which provide for certain language barriers. Overcrowding is also a reality among many of the patients. This, along with high workloads and the time constraints placed on doctors does not leave adequate space to make sure every individual patient understands and will remember self-isolation rules.
SH is also the drainage hospital for many clinics in the area (such as Kayamandi, aan-het-pad, etc.) and therefore is responsible for the health of quite a big population.
Problem statement
THERE IS A LACK OF ADHERENCE UNDER COVID-19 TESTED PATIENTS WITH REGARDS TO SELF ISOLATION PROTOCOLS. THIS HOLDS A RISK FOR RAPID SPREAD OF INFECTION IN A RESOURCE-LIMITED SETTING.
Problem
Statement
fishbone analysis of problem and context
Literature Review
LIT REVIEW
Protocols for Self Isolation
Visual Patient Education
Survey Testing (Likert Scale)
Visual aids in patient education setting
- Moll JMH, et al. Doctor-patient communication in rheumatology: studies of visual and verbal perception using educational booklets and other graphic materila. Ann Rheum Dis 2016, 45:198-209
- Rohert, L. Furguson, KJ. Effective use of Patient Education Illustrations. Patient Education and Counselling. 1990; 15:73-75
LITERATURE
- Bares, SG, et al. Implementation of an HIV clinic based inter-professional education curriculum for nursing, medical and pharmacy students. Journal of Interprofessional Education and Practice. 2018. 11:37-42
The AIM
Improving the understanding of self-isolation in the hopes of approving adherence
STAKEHOLDERS
ENGAGING STAKEHOLDERS
- Community members who need to self-isolate
- Doctors at SH working in the testing center
- Western Cape Department of Health
- Volunteers phoning patients with COVID-19 test results
PLAN
- Community members received handouts in their own language after testing and posters placed at testing center
- Documents easily accessible to doctors at testing center
- Western Cape Department of Health protocols used for information
- Volunteers were asked to help complete surveys
IMPACT
MEASURES
- Community members were excited about the posters and pamphlets and enjoyed the visual representations leading to better understanding and thus adherence
- Doctors were eager to use our intervention as it cut down on the time they needed to spend with each patient at the testing center
- Volunteers were impressed with increase in adherence
- PROCESS MEASURES
- OUTCOME MEASURES
- BALANCING MEASURES
THE PLAN
OBJECTIVES
OBJECTIVES
Supply doctors with an easy way to communicate information
Make information available in afrikaans, english and isxhosa
Make information regarding self-isolation protocols easily understandable by all members of community who come for testing
Specific Measurable Attainable Relevant Time-bound
(SMART) AIM STATEMENT:
SMART AIM
WE, STELLENBOSCH HOSPITAL AIM TO IMPROVE PATIENT ADHERENCE TO WESTERN CAPE DEPARTMENT OF HEALTH SELF ISOLATION REGULATIONS FROM A BASELINE OF 30% ADHERENCE TO 60% ADHERENCE (30% INCREASE) BY THE END OF JUNE 2020.
DO
TASKS NEEDED FOR CHANGE
TEST OF CHANGE
PREDICTED OUTCOMES
& TIMELINE
WHEN:7-24 JUNE 2020
WHERE: TESTING CENTRE
PRINT PAMPHLETS AND PUT UP POSTERS WITH NEW INFORMATION
WHO:D&Z
DANNI
ZOË
1
3
WHETHER PATIENTS ARE CAPABLE OF SELF-ISOLATING ADEQUATELY AFTER COVID-19 TEST, WITHOUT RECEIVING THE REVISED PAMPHLET
WHO: PATIENTS AND D&Z
WHEN: WEEK PRIOR TO IMPLEMENTATION (1-6 JUNE 2020)
WHERE: PATIENT HOMES (VIA PHONE)
DO
2
SUPPLY PATIENTS WITH INFO IN THEIR OWN LANGUAGE
WHO: TESTING DOCTORS
USE GOVERNMENT APPROVED SELF-ISOLATION PROTOCOLS AND TRANSLATE THEM INTO VARIOUS LANGUAGES
WHO: D&Z
TIMELINE
- 1-6 JUNE: PROBLEM IDENTIFICATION
- 8-13 JUNE: BASELINE STATISTICS AND IMPLEMENTATION AT SH
- 15-20 JUNE: STATISTICS ON SH AND SECOND CYCLE IMPLEMENTATION AT KAYAMANDI CLINIC
- 22-24 JUNE: FURTHER STATISTICS GATHERING
PREDICTED OUTCOME:
INCREASE ADHERENCE TO SELF-ISOLATION RULES AMONG COVID-19 TESTED PATIENTS
MEASURES TO DETERMINE SUCCESS:
1. DETERMINE BASELINE BEHAVIOUR
2. DETERMINE ADHERENCE BY MEANS OF A SURVEY
STUDY
AVAILABILITY OF MATERIAL
SPECIFIC AREAS OF PROTOCOL
STUDY
3
4
2
1
DATA FROM CYCLE TWO
OVERALL IMPROVEMENT IN ADHERENCE
SURVEY
THE SURVEY
OVERALL IMPROVEMENT IN ADHERENCE
Sample size:
- 75 prior to intervention
- 75 post intervention
- TOTAL: 150
ONE
Criteria:
- Good isolation >80%
(20/25)
Results: 42% increase
SPECIFIC AREAS OF PROTOCOL
TWO
DATA FROM CYCLE TWO
Kayamandi
THREE
Sample size:
- 25 prior to intervention
- 25 post intervention
- TOTAL: 50
32% increase in one week
AVAILABILITY OF MATERIAL
FOUR
ACT
CONSTRAINTS
WHAT DID WE LEARN?
ADOPTIONS
RECOMMENDATIONS
A SIMPLE TASK CAN BRING FORTH A MEANINGFUL CHANGE. THE FACT THAT THE WHOLE TEAM BOUGHT INTO THE IDEA WAS A GREAT MOTIVATOR TO PROVIDE GOOD WORK FOR THIS PROJECT.
ACT
ADAPTATIONS
PRINTING AND COPYING THE INFO SOMETIMES PROVED DIFFICULT AT THE CLINICS AS WELL AS AT SH. TECHNICAL DIFFICULTIES AND PAPER PROBLEMS ETC. SOMETIMES HINDERS THE PROCESS AND IS THEREFORE A SIGNIFICANT FACTOR IN A RESOURCE LIMITED SETTING
POSSIBLY SPREAD THE PAMPHLETS TO THE OTHER REMAINING CLINICS AND WORK IT INTO THEIR PROTOCOLS AS WELL.
3
THE PROJECT WAS SIMPLE TO ADOPT BY ALL PARTIES INVOLVED AND THEREFORE RELATIVELY EASY TO CONTINUE.
4
2
1
IN FUTURE, POSSIBLY OTHER LANGUAGES COULD BE ADDED TO THE LIST AND A VIRTUAL VERSION OF THE INFO COULD BE CIRCULATED.
REFLECTION
REFLECT
REFLECTION
1
2
SUSTAINABILITY
SUSTAINABILITY
- Good quality laminated poster (durable and easy to clean)
- Access to all material for doctors
- Contact details supplied in-case of editing is needed
REFLECTION
We believe that even in the short time frame of implementation this project showed that it reached its AIM and is sustainable.
We greatly enjoyed the experience. It was great to see the big impact made by a small intervention. Something as simple as providing information in three languages proved extremely valuable to our community.
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