Thuy Trang Nguyen ThiHloliphani Juta

Jasmine PaulLara Kesteloo

Quality Improvement: Treatment of Post Disaster Diseases in Viet Nam

Health Issue: Treatment of diarrhea post disaster

What is diarrhea?

• Occurrence of loose, watery, and frequent stools. Stool and vomit are highly contagious

• Common causes: viral gastroenteritis (stomach flu), medical conditions, or by eating or drinking contaminated food or water (in Viet Nam during floods)

• Treatment: – Fluids such as water and Pedialyte– Oral rehydration therapy– Intravenous fluid– Monitoring

How do nurses in Viet Nam treat diarrhea after a disaster?

• Hanoi, Vietnam: 1 in 10 paediatric patients are hospitalised due to complications of diarrhea and during natural disasters the number increases

• Use of buckets under beds to catch stool. Buckets are then washed and disinfected with chlorine

• Shortage of nursing staff and hospital beds due to inadequate funding → diarrheal patients are treated as outpatient and only a few can be hospitalised.

Post disaster issue: Diarrhea

• Despite strong improvements in key social indicators, water and sanitation and related diseases remain a major health problem following disasters in Vietnam. Polluted drinking water and swampy conditions substantially increase the risk of cholera, diarrhea, dengue fever, and malaria outbreaks. More than 70 percent of Vietnam’s 85 million people live in rural areas. While a large majority of rural communities have access to improved water sources, great disparities remain in access to clean water

Why focus on diarrhea as a health issue following a disaster?

• “Although symptoms may be mild, approximately 5%-10% of previously healthy people will develop a copious diarrhea within about one to five days after ingesting bacteria from contaminated sources such as water and food”

QUALITY IMPROVEMENT THEORIES:

FADE ModelMicrosystems Model

FADE model

• → Focus• → Analyze• → Develop• → Execute/Evaluate

Relevance of the FADE model

• The FADE model allows the nurse to focus on a concrete issue (diarrhea post disaster) and use baseline data (how many cases of cholera → diarrhea/ what are the rates of morbidity and mortality) to either:– Improve care/implement care– Reduce errors that are leading to high rates or

morbidity or mortality

– For example...

Microsystems model

• Provides practical steps for designing/redesigning components of the microsystem to perform optimally in alignment with guidelines and policies

• Use of four “P’s” to guide patient-centered care:- Patients- People- Processes- Patterns

Relevance of the microsystems model

• Places the patient at the forefront

E.g. Not placing patients with diarrhea beside those who are being treated for an open wound because doing so→ further spread of disease (based on evidence-based practice)

Drawback of the microsystems model

• “Excellent planned care requires that the microsystem have services that match what really matters to a patient and family and protected time to reflect and plan. Patient self-management support, clinical decision support, delivery system design, and clinical information systems must be planned to be effective, timely, and efficient for each individual patient and for all patients”

• Yes this is possible in a microsystem, but is it possible to achieve in one whose main concern is disaster management/care?

Six Sigma ModelTQM Model

Discarded theories

Discarded theories

• Six Sigma • TQM Model

Define

Measure

AnalyzeImprove

ControlResults

Customer Focus

Planning Process

Process Management

Process Improvement

Total Participation

A.D.A.M. Medical Encyclopaedia. (2012). Diseases and conditions: Diarrhea. Retrieved April 18, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0003613/

De Koning, H., Verver, J. P., Van den Heuvel, J., Bisgaard, S., & Does, R. J. (2006). Lean six sigma in healthcare. Journal for Healthcare Quality, 28(2), 4-11. doi:10.1111/j.1945-1474.2006.tb00596.x

Duke Medical Center Department of Community and Family Medicine. (2005). Patient safety: Quality improvement. Retrieved April 19, 2012, from http://patientsafetyed.duhs.duke.edu/module_a/methods/fade.html

George, M. L. (2003). Learn six sigma for service: How to use lean speed and six sigma quality to improve services and transactions. NY, NY: McGraw-Hill.

Medicine Net. (2012). Disease & conditions: diarrhea. Retrieved April 19, 2011, from http://www.medicinenet.com/cholera/article.htm

Nelson, E. C., Batalden, P. B., & Lazar, J. S. (2007). Practice-based learning and improvement: A clinical improvement action guide (2nd ed.). Oakbrook Terrace, Illinois: Joint Commission Resources.

Nguyen, H.N., Trung, K.V., & Niem, N.V. (2007). Fighting climate change: Human solidarity in a divided work. Flooding in Mekong River Delta, human development report 2007/2008

Ovretviet, J. (2000). Total quality management in European healthcare. International Journal of Health Care Quality Assurance, 13(2), 74-80. doi:10.1108/09526860010319523

Patel, G. (Biomedical Engineer). (2012). Total quality management in health care [PDF]. Retrieved from http://www.biomedicalprojects.com/files/TQM%20in%20Healthcare.pdf

Path. (2010). Keeping a focus on diarrheal disease control in Viet Nam. Retrieved April 18, 2012, from http://healthmarketinnovations.org/sites/healthmarketinnovations.org/files/VAC_ddc_vietnam_fs[1].pdf

Raisinghani, M. S., Ette, H., Pierce, R., Cannon, D., & Daripaly, P. (2005). Six sigma: Concepts, tools, and applications. Industrial Management & Data Systems, 105(4), 491-505. doi:10.1108/02635570510592389

Wasson, J.H., Godfrey, M.M., Nelson, E.C., M, J.J., & Batalden, P.B. (2003). Microsystems in healthcare: Part 4. Planning patient-centered care. Joint Commission Journal on Quality and Safety, 29(5), 227-237

References

Search process

• We started by looking at our first presentation, which was a broad topic of disaster preparedness in Viet Nam, and individually researched specific issues that occur both in the acute phase, and the long term phase

•Choosing the acute phase and attempting to find an issue in which nurses were the focal point proved to be difficult; we then strategized and researched common health issues post disaster that nurses encounter in Viet Nam

•From here we found that Cholera was a common and specific health issue, occurring both in rural and highly populated cities after disasters. However, we refined this to treatment of diarrhea, as this seemed to be a more concrete and specific health issue to link to the theories we chose

• We used scholarly databases such as CINAHL, Pub Med, The World Health Organization, and other scholarly work from American and European accredited journals

• We initially collaborated as a group to research and decide which topic would be appropriate. We each brainstormed one specific topic and came back to the group to discuss why we thought it would be a relevant topic. To choose one, we went back to the research to support each topic, which led to our final decision

•From here we worked individually but contacted each other through e-mail and Facebook to gain new ideas and knowledge

•Each member of the group had the choice to decided which topic she wanted to focus on. One group member was in charge of creating the Power Point after each member was done her slide(s)

•Another member of the group read over the power point for spelling errors and to ensure the references were scholarly and appropriately cited

Collaboration