Review of Interburns Activity

Prof Tom Potokar

Centre for Global Burn Injury Policy & Research

University of Swansea

Wales

UK

Set standards

•Systematic consensus approach

Assess Services

•Peer evaluation, focus groups, objective review & PROM’s

Capacity Building

•Tailored, contextual education & training, process & protocol development, material support

Review •Peer evaluation, focus groups, objective review & PROM’s

Framework

Summary of Quality Improvement

Program (Nepal / Bangladesh)

12 of 14 services demonstrated an

improvement in score over 1 year,

including all Intermediate and

Advanced services

8 of 14 demonstrated improvements in

2+ service areas

Improvements impacted an inpatient

population of 6,399 patients across

these 12 services during this year

Follow-up assessments in 2016 show

a similar level of improvement

• Training & Education

• Conflict Related Burns

• Prevention

• Advocacy

• Service Assessments

• New Developments

Training & Education

• ABC Nursing (Bangladesh,

Ghana)

• ABC Rehab (Bangladesh)

• EBC (Ghana, Malawi,

Palestine, Nepal,

Bangladesh, India)

• Publication of EBC manual

• Opening of 2nd ITC in Nepal

• Consensus meeting on

policies, procedures and

outcomes

ABC Nursing

• Bangladesh &

Ghana

• Faculty from UK,

India, Ethiopia,

Ghana, Nepal,

Malawi

• Highly interactive

• 5 days

ABC Nursing

ABC Rehabilitation

Publication of Essential Burn Care Manual

• Taught independently in

Nepal, Bangladesh,

India, Ghana, West

Bank

• Over 3000 trained

• Endorsed by PABS,

NBS, BSBI, ECPB,GBA

Opening of second ITC , Nepal

• Clinical Fellowships

• Visiting Faculty

• Educational tool

development

• Research

Consensus meeting on Policies and Procedures

• 1. DailyChecklistforBurnPatient

• Has the observation chart been reviewed today?

• Has the medication chart been reviewed today?

• Have investigations been reviewed today?

• Is pain adequately controlled?

• Does the dressing need to be changed today?

• Do the wounds need to be assessed today?

• Is surgery required?

• Are nutritional needs being met?

• Is the patient mobilising appropriately?

• Is the development of the contracture being

prevented/addressed?

• Are healed areas being treated appropriately?

• Have the psychosocial needs of the

patient/family been addressed?

Conflict Related Burns

• Training programs on ‘Burn

injury in Conflict Scenario’

(MSF, WHO)

• Workshop on Pre-hospital

care of conflict related burns

(Lebanon, inc Middle East

and North Africa Medical

Students Society)

• Consultancy advice to WHO

on burns services

responding to conflict in

Mosul, Iraq

Training programs on ‘Burn injury in Conflict

Scenario’ (MSF, WHO)

Agenda for MSF Training Rome 8 - 10th June 2016

WEDNESDAY 8th TIME FACULTY LEAD

Introductio

n

s 09:00 – 09:30 Tom Potokar

Preview of Program 09:30 – 10:00 Tom Potokar

Focus on Rehabilitation

10:00 – 13:00Ruthann Fanstone

Lunch 13:00 – 14:00

Focus on Nursing 14:00 – 17:00Dominique

Navet

THURSDAY 9th TIME FACULTY LEAD

Assessment & Acute

Management08:00 – 11:00 Tom Potokar

Critical Care 11:00 – 13:00Redouane

Bouali

Lunch 13:00 – 14:00

Reconstructive Surgery

14:00 – 17:00 Stuart Watson

FRIDAY 10th TIME FACULTY LEAD

Chemical Weapons 08:00 –09:00 Tom Potokar

Mass Casualty Scenario

09:00 – 12:00 All

Lunch 12:00 – 13:00

Case Discussions 13:00 – 14:00 All

Round Table 14:00 – 15:00 All

MSF Guidelines 15:00 – 15:30 Remy Zilliox

Summary & Close of Workshop

15:30 – 16:00 Tom Potokar

This three day workshop will focus on the practicalities of managing burns in a low resource and / or conflic t environment and highlights the comprehensive, holistic approach delivered by a committed team as recommended by Interburns. It will consist of mixed methods including presentation s , small group discussions, practical demonstration s , scenarios, video clips and will be highly partic

ipa tory. By the end of the workshop all

partic

i

pan ts should have the knowledge, skills and attitu des to manage burns effectively but also to understand the limitation s of treatment. There are many simple, cheap and effective techniques and processes that can significantly improve outcomes, even in a severely resource restricted environment. Emphasis will be placed on implementation of good practice (translating knowledge to actio

n) .

Focus on Rehabilitation

General Principles

Introduction

t o comprehensive rehabilitation , development of rehabilitation pr escription

Pulmonary Care

Prevention

and tr eatment of pulmonary complication s

Positio

n

i ng

Description and demo ns tration of appr opriate positio

ni ng , tips on how to achieve correct

position

i ng and the c onsequences of inappropriate positio

ni ng

SplintingDescription and demo ns tration of c orrect

splinting , including use of available materials and supervision

MobilisationImportance of mobilization in pr eventing

complication s , me thods and techniques for encouraging mobility

Scar Management

Description of mo der n sc ar management modalitie

s and pos si bi lities

f or utili z ation in low resource environment

Knowledge to Actio

nCase discussions and demonstration s

Focus on Nursing

General Principles Importance and scope of nursing role in management of burns

Hygiene Ward and personnel management, creating a dedi c ated area for burns, importance of policies

Nutritio

n

Role of nutritio

n

in bur ns , r ole of the nurse in promoting g ood nutrition inc l udi ng supplemental feeding

Dressings Overview of dressing materials and indication s f or each. Description and demo ns tration of assessing, cleaning and dressing wounds

Pain & Suffering Pharmacological and non pharmacological approaches to pain management. Background, breakthrough and procedural pain.

Psycho Social Care Communication , r ole of the family, discharge and follow up planning

Knowledge to Actio

n Case discussions and demonstration s

WHO Consultancy MissionReport:BurnCareServicesinErbilwithRespecttoCurrentConflictinMosul

Author:ProfTomPotokar CentreforGlobalBurnInjuryPolicy&Research DirectorInterburns

(OnBehalfofWHO)

VisitDates:24-27March2017

Confidential

MEMA Global Conflict &

Health Meeting

Prevention

• Consensus meeting on

basic burn care and

community burn care

• Community surveys

(Ghana and Nepal)

• Pilot study on training

female health workers

in Nepal

Planning,Implementing&EvaluatingPreventionProgrammes

- ThoughtProvokers-

TomPotokarFRCS(Ed),FRCS(Plast),DA(UK),DTM&H

ProfofGlobalBurnInjuryPolicy&ResearchCHHSSwanseaUniversityConsultantPlasticSurgeon

WelshCentreforBurns&PlasticSurgeryDirectorInterburns

Advocacy

• WHO – Global Alliance for Care of the

Injured

– Global Initiative for Emergency and

Essential Care

– EMT Systems

• MSF, ICRC, UKIETR, HI etc

• Publications & Presentations – Burns Scars & Healing

– Conflict & Health

– MEMA

– MBS

– ECPB

• Social Media – Interburns Global Group

– Interburns Student Support

– Twitter

– Website

Service Assessments

• Revision of service

assessment tools and

evaluation process

• (Comprehensive

integrated approach to

capacity building and

quality improvement)

• Ghana

• Palestine

• Iraq

• Afghanistan

• Nepal

• Bangladesh

Evolution of the DAT

DAT Version 1

(2013-4)

8 sections scored 1-4

Services receive an overall aggregate

score out of 32

Basic services scored in 5 areas,

aggregate score out of 20

Equipment and Facilities not scored

DAT Version 2

(2014-6)

10 sections scored 1-4

(2 new sections on Equipment and

Data/Outcomes)

Services receive an overall aggregate

score out of 40

Basic services scored in 6 areas,

aggregate score out of 24

Review scorecard for back-end

scoring of services introduced

DAT Version 3

(2016)

10 sections scored 0-10

Services receive an overall aggregate score out of 100

Introduced granular sub-section scoring

Additional detail added to review

scorecards

DAT: Assessing 10 Key Aspects of a Burn Service

1. Policies and

Procedures

2. Burn Service

Activities

3. Burn Care Team

4. Surgery

5. Assessment

6. Treatment

7. Rehabilitation

8. Patient Support

9. Outcomes and Data

10. Equipment and

Facilities

DAT Process

Focus group discussion

with local staff

Local M&E/ programme staff

feed back results to Interburns

Service scoring and reporting

by Project Director

Review of scoring and evidence by

senior Interburns faculty

Scoring and recommendati

ons shared with local staff

Team of 3 local

staff:

Facilitator, note-

taker, observer

BANGL

A 2016

1 2 3 4 5 6 7 8 9 10 SCORE

Policies Activiti

es

Team Surgery Assess. Treat. Rehab Suppor

t

Data Equip. Total /40

B-001

NIBPS

3 3

+1

3

+1

3 3 3 3

+1

2

+1

2 4

+1

24 -> 29

+5

B-002

SSMC

4 2

+1

3 4 4 3 3

+1

1 2

+1

4

+1

26 -> 30

+4

B-003

CMC

3 2 3

+1

3 3 3 3

+1

2

+1

1 4

+1

23 -> 27

+4

B-004

Gazipur

2 1 3

+2

2 3 3

+2

2

+1

1 1 2

+1

15 -> 21

+6

B-005

Manikga

nj

2 1 2

+1

2 3

+1

3 2 1 1 2 17 -> 19

+2

B-006

Savar

2 1 N/A

Basic

N/A

Basic

3 3

+1

2 N/A

Basic

N/A

Basic

3

+1

12 -> 14

+2

B-007

Sreepur

2 1 N/A

Basic

N/A

Basic

3 3

+1

2 N/A

Basic

N/A

Basic

3

+1

12 -> 14

+2

Overall

total

18

+0

9 -> 11

+2

9 -> 14

+5

14

+0

21 ->

22

+1

17 ->

21

+4

13 ->

17

+4

5 -> 7

+2

6 -> 7

+1

16 ->

22

+6

129 ->

154

+25

New Developments

Centre for Global Burn Injury Policy & Research

Analyse ImpactAct

Reducing the Burden of Global Burns

Implementation Science

Health Systems &

Policy Research

Health Economics

Prevention

Outcome & Impact

Assessment

Why Implementation Science?

• Affordable, effective

interventions exist to

reduce morbidity and

mortality, but little

understanding of how

best to deliver these

across the full range of

existing health systems

and wide diversity of

possible settings

World Health Organisation

• Through shifting the

paradigm into

implementation based

strategies we can start

to ensure that those

most in need benefit

from a shared global

knowledge resource

CGBIPR

• Global repository of

resources for burn

care and prevention

• Advocacy

• Policy development

• Consultancy to Govt

and Non Govt

organisations

• Impact based

research and

development

• Provision of

educational

programs and short

courses

• Masters and PhD

programs

2 Million Pound Grant

• Quality

Improvement

• Prevention

• Mass casualty burns

and conflict related

burns

CGBIPR Interburns

The Future

Changing what

is happening

to what

should

happen