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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

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