patient safey tonny tumwesigye ccih 2016

Uganda Protestant Medical Bureau

Health Systems Strengthening through Faith, Innovation and Vigilance

30th CCIH Annual Conference 2016

Baltimore, Maryland 19TH June 2016

Dr. Tonny Tumwesigye

EXECUTIVE DIRECTOR

www.upmb.co.ug Health in Totality

• UPMB Founded in 1957,

• National PNFP Coordinating body for Protestant health services in Uganda.

• Network of 290 Health Institutions in Uganda

• Approximately 80% of the member institutions are located in rural and poor communities across Uganda.

• PNFP Network covers about 40% of Hospital Beds in and 60% of Nursing Training in Uganda

• UPMB covers about 40% of the PNFP services


PNFP Facilities across Uganda (DHIS2 – GIS – Over 70 facilities missing from this map)


Contribute to all health system building blocks and levels of care


Change Model

• Based on partnership work • Based on 6-step process-Successes

and Challenges


• Situational Analysis (SA) conducted WHO-APPS tool used – Long Form (For this presentation-only four areas identified for action are discussed)

• Patient safety team formation stimulated through the SA


Healthcare Associated Infections

• No clear structures and mechanisms for infection prevention and control (IPC)

• No human resources designated for IPC activities

• No written policies and or guidelines in all areas of IPC

• No methods to assess compliance

• No system in place to conduct health worker training

• No hand hygiene system in place


Healthcare Waste Management

• A lack of total systems thinking for waste management.

• Nonexistent hospital policy on health care waste management.

• Some guidance on waste segregation, transport and disposal, but no capacity to handle toxic, chemical and radiation waste.

• No facilities for appropriate temporary storage of waste.

• No protocol on environmental cleaning communicated to cleaning and supervisory staff.

• Very limited training in health care waste management.


Key Steps

• Situational analysis findings were discussed at the Hospital Management Committee (HMC).

• Identified the four priority areas for action following examination of all situational analysis findings.

• Concentrated on how best to tackle the gaps identified in the situational analysis

• Community engagement

• Appointed an APPS team (Kisiizi APPS team).

• Discussions held across the partnership.

• Launched the Program


• Action Plan formulated and agreed

• Done through face to face meetings, teleconference and email

• Action Plan approved by the Hospital Management Committee & BOD

• Action Plan approved by WHO APPS.


Innovation-Kisiizi vs WHO Surgical Checklist


Health Care Waste Management


• Identification of Lead Professional

• Appointed a Drugs And Therapeutics Committee

• Training Programme on Medication Safety

• Introduction of Prescribing Standards Document

• Surgical Antibiotic Prophylaxis Policy

• Audit tool – Prescribing Guidelines

• Emergency Red Drug Boxes - Wards/Departments

• Computer based medicines management system.

Medication Safety


Evaluation

• Program now sustained and in Budget

• Scale up to other Hospitals

• New Partnerships have been developed-AIPJHM


Challenges

• Culture differences • Initial fear of change • Lack of Chester teams knowledge and experience

of working in a developing country • Communication/maintaining relationships • Maintaining momentum • Significant differences in facilities/equipment • High expectations/Goal setting • Sustainability


• Keeping of old “Prestigious” traditions

• Knowledge gap

• High expectations of partners

• Lack of facilities/equipment

• Sustainability-Local production at hospital of ABHRs

• Soap stolen

• Cold weather with no air conditioning


Key lessons

• Involve the entire Hospital and ensure early and visible Executive support

• Consider utilizing a mutually beneficial partnership approach for capacity building

• Involve and listen to patients and the community

• Focus on Knowledge and skills that are applicable

• Modify the approach to suit local culture

• Ensure a multidisciplinary approach


Key lessons

• Resourcefulness is key as resources will always be limited

• Harness individual passion for change! • Change is possible in an African Hospital • Systematic planning is critical • Programme can be replicated • Document everything-Good & Bad • Alignment with both Institutional and

National Strategy


• I have learned to believe in the philosophy of “Learning as we do”

• This appeared as theory but it’s now practice…


The future is bright…


THANK YOU 39

patient safey tonny tumwesigye ccih 2016

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