Kudos to Nkwanta South Hospital
The Nkwanta South District Hospital in the Volta Region was this week honoured with the best poster award at Ghana’s first National Quality Forum after sharing an engaging story of how multiple facility-based interventions led to a rapid reduction in deaths from malaria in children less than five years.
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It all started in July 2013 when the hospital’s management established a multidisciplinary quality improvement (QI) team to better understand the various process failures accounting for the high deaths of children under five. The team was made up of the medical superintendent, a midwife, the nurse in charge of the OutPatient Department, a pharmacist, laboratory technician, a health information officer, the nurse in charge of the Accident and Emergency Unit and was led by the deputy nurse manager.
Problem analysis
The QI team analysed 18 months of baseline data prior to July 2013 and realised that almost 40 per cent of under five deaths were attributable to malaria. In addition, protocols for treating malaria were not available at all service delivery points and even where they were available, they were not always correctly adhered to by health providers during treatment. Delays in providing care were other contributory factors.
Interventions implemented
The team then set itself the ambitious goal of reducing malaria-related deaths by 50 per cent from 28.2 per 1000 admissions to 14.1 per 1000 admissions by December 2015. With the active support of the hospital’s management, the QI team developed, tested and in some cases, implemented the following ideas; trained prescribers and some nurses in malaria management protocols, pasted copies of protocols for treating severe malaria on consulting room walls, instituted a system for prompt stabilisation of critically ill under fives in the emergency room, including making items for tepid sponging readily available.
In addition, they increased prompt access to emergency medications by placing them on the wards. They then tagged all laboratory requests for emergency cases “urgent” in order to fast-track care. Finally, to reduce delayed care seeking, the QI team organised health talks on prompt care seeking both at the OutPatient Unit and at the local radio station.
To know whether changes tested were in fact leading to improvement, the Nkwanta South QI team tracked their results on a monthly basis. They also shared all results with the hospital’s management and other members of staff during regular clinical and mortality audit meetings and also during peer-to-peer meetings organised by the Volta Regional Health Directorate to enable hospitals in the Volta Region to share best practices and other experiences in the effort to improve the quality of care and improve child survival.
Results
Starting with an adherence to malaria treatment protocol around 60 per cent, the hospital has, since July 2014, consistently ensured that all children less than five diagnosed with malaria are treated in line with clinical standards and protocols prescribed by the Ghana Health Service.
Protocol adherence is, therefore, now recorded at 100 per cent. The time for identifying critically ill children has also reduced. As of July 2015, the median mortality rate was 7.9 per 1000 admissions thus, signifying a 79 per cent reduction in facility-based deaths in children suffering from malaria.
In the view of the QI team, “involving all staff in quality improvement work sustains interest and commitment” while advising that “the evidence-based approach is the best way to engage and lobby management to commit more resources for QI work. Also collecting, processing, analysing your local data in a timely manner is the only way to assess one’s improvement in work.”
The Nkwanta South District Hospital was represented at the National Quality Forum by Mr Robert Adatsi, the Deputy Director of Clinical Care for the Volta Region, Josephine Kporngor, nurse in charge of the Children’s Ward and a trained Improvement Coach, Catherine Obosu, Regional Chief Nursing Officer. The hospital has 84 beds with a daily outpatients’ attendance of 108.
The forum was organised under the aegis of the Ministry of Health on the theme: ‘Safe and Better Quality Care – Developing an Integrated Approach for Improved Health outcomes in Ghana.’ The forum rallied all stakeholders on the health quality landscape in Ghana, discussed how to mainstream quality across the health system and celebrated ongoing quality improvement initiatives in the Ghanaian health system. Among the next steps planned is for the Ministry of Health to lead the development and implementation of a harmonised National Quality Strategy in partnership with all of its agencies and committed partners.