From the HIVQUAL International Update

 HIVQUAL-Namibia QI Spotlight: TB screening and prevention

After the first data collection and analysis were completed in early 2008, Rehoboth Hospital recognized an opportunity to improve TB screening and Isoniazid Preventive Therapy (IPT) rates.  A meeting was held with the entire HAART and PMTCT teams, during which causes for the low performance rates were discussed.   The main problem identified was the lack of documentation for screening and prevention services actually provided.

A fishbone diagram was completed by the group (see below) to identify other possible causes for low rates of IPT and TB screening.  Four main areas for intervention were identified.  To improve documentation, IPT charts are being made available.  Staff were encouraged to use the new forms.  TB screening rates were to be improved via team discussions and training, followed by encouraging proper documentation of screening activities in patient files.  Sputum collection and handling procedures are being improved by reminding staff of the proper protocol, and educating patients on how to collect proper samples.  Finally, patients have been targeted for education about IPT, to help improve adherence and understanding of the importance of the prophylaxis regimen.

With agreement from the facility staff, the interventions are ongoing.  Already, TB screening appears to have improved at the hospital, as shown by an informal examination of patient records.  The staff reports that they are more conscious of the need to screen patients for TB and to document their findings in the patient’s chart.  It is hoped that significant improvements will be seen with the HIVQUAL-Namibia follow-up data collection later this year.

The fishbone diagram completed by the Rehoboth team, outlining the multi-factorial causes of low TB screening and IPT rates.