SMART MONITORING TA PLAN round 1 (August 2014)

USAID/SMART TA
Assessment Period
date
Date of assessment
OPC name

Jan 2014

to

June 2014

28 August 2014
MMT & Care and treatment in DienBien District (Opened in 2009)
Services provided

ARV Adult
ARV Pediatric

HIV testing

MMT

PMTCT

HBC

Out-reach

TB

STI

Regional character

City

Urban

Mountainous

Patient in prison/detention center

Ethnic minority

C IM KHC

Patient managed:
Key OPC staff

Name

( 85

Nguyn Th Bch Thc

L Vn Quc

3.

Nguyn Th Ngc Anh

4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

Nguyen Thi Hien

Chu Thi Bich Hao
Nguyen Thi Luong
Luong Thi Phuong
Luong Hau Tan
Luong Thi Hang
Tran Thi Thu Thuy
Do Kim Ngan
Tong Thi Be

Total

OPC chief

( (% Total client)

430

Tittle

1.
2.

Project monitor
USAID/SMARTA

(% Total client)

Treatment doctor
Treatment doctor
Administrative
Officer
Treatment nurse
Pharmacist
HBC leader
Counsellor
OPC chief
Pharmacist
Pharmacist
Reception nurse
Lab nurse

Part-time
(GVN staff)
X
X

12

PAC representative

Full time
contracted

X
X
X
X
X
X
X
X
X
X

Assessment data file

File nh gi d n
USAID/ SMART TA

Nguyn c Anh

Dr. Luong Hau Tan

Nguyn Thin Hng

1|Page

SMART MONITORING TA PLAN round 1 (August 2014)

USAID/SMART TA
Assessment content
A

Result

Human resource

A. Human
resource

88%

Data structure and

assessment

59%

Drug supply

80%

Lab capacity

90%

Data control

70%

Case management

17%

Service delivery (ART/ preART)

60%

G. ART/PreART service
delivery

100%
80%
60%
40%
20%
0%

B. Structure
and access

F. Case
manament

C. Drug
supply

E. Data
control

D. Lab
capacity

SMART MONITORING INDICATOR AND HIVQUAL RESULT

Microsoft Excel
2003 Worksheet

TT
1

Name of indicator

Target

Proportion of patient chart pass 80% of chart

scoring (chart review tool)
Proportion of client newly registered at the OPC
in last 6 months and tested for CD4 within 15
days of enrolment

1/4/13 30/9/13

1/10/13 31/3/14

Last result

Current
result

Diff

Score

80%

100%

75%

46%

75%

62%

80%

92%

85%

86%

95%

64%

75%

83%

Proportion of patient were CTX prescribed

Proportion of patient were TB screening at the
last visit
Proportion of patient had CD4 testing every 6
month

90%

89%

80%

100%

85%

89%

11

ART retention after 12 months of starting ART

85%

77%

12

Retention rate after 12 month of registration

85%

72%

3
4
5
6
7
8
9
10

Proportion of pre-ART patients visiting the OPC

regularly and per appointment with doctor
Proportion of patient was INH prescribed in last
6 month
Proportion of ARV patients visiting the OPC for
medication pick-up according to scheduled
appointment in the last visit
proportion of patient were adherence
assessment in the last visit
Proportion of eligible clients initiating ART
within 30 days during the past 6 months

SMART monitoring score

Classified

Notes

Smart
monitoring
indicator
Smart
monitoring
indicator

Smart
monitoring
indicator

Smart
monitoring
indicator

Smart
monitoring
indicator
Smart
monitoring
indicator

2
Improving

2|Page

SMART MONITORING TA PLAN round 1 (August 2014)

USAID/SMART TA

TT

Issues

HUMAN RESOURCE

QI activities

Responsible

Supporter

Deadline

Note

Fix:

Treatment nurse (Hien) write

patient chart, medication but do
not have official training on ARV

Dr Thuc review patient chart in

the end of working day and
discussed with Hien
Send Hien to Official ARV training
when available
Clinical mentor (FHI, PAC) come
and provide on job training to
HIen

Dr Thuc

Fix:
2

Dr. Quoc and Dr. Thuc have too

little time to provide patient
examination and patient review

Dr Quoc and Dr Thuc review and

sign patient chart every week
Treatment doctor need spend
more time on OPC

Dr Thuc
Dr Quoc

PAC (Khuyen)
FHI360 (Dr Thuy)

Deputy of
District health
center leader
(Luong Hau Tan)

STRUCTURE AND ACCESS

Plan: All staff understand and follow
Universal Precaution
Do:

Some new OPC staff have not

trained on Universal Precaution

Print-out training material for

Universal Precaution for
reference
OPC chief giving request to all
staff to complete self-training on
Universal Precaution
Hand washing is clearly displayed
and soap is available for hand
washing

OPC chief
and all staff

September,
2014

PDSA 1

Study: OPC chief interview all staff on

understanding of universal precaution
every three month

3|Page

SMART MONITORING TA PLAN round 1 (August 2014)

USAID/SMART TA

Action: Respond to staff feedback

Plan: Counselor use chart and job aids
when giving counselling

Lack of Job aids for patient

counseling

Do: SMARTA send 2 set of patient

counselling picture book to OPC for
patient counselling
Study: Interview with staff to confirm that
job aids are available, understandable,
and use frequently

LoanCounselor

SMARTA
Duc Anh

Treatment
doctor
Reception
nurse

SMARTA send
instruction of
cough/spit to
OPC.

September,
2014

PDSA 2

Action: OPC chief is monitoring the use of

job aids in counseling service provided
Plan: Implement the examination for
TB/TB suspected patient, improving
infection control
Do:

No fast examination for TB

active/suspected

No spit/cough instruction at
patient waiting area

No medical mask for TB

suspected patient
Study

Discuss and build fast patient

flow for TB/TB suspected patient.
OPC buy medical mask and give
to TB suspected patient
Reception nurse deliver mask to
all TB/suspected as routine
practice
Instruction of cough/spit
available

PDSA 3

Count on how many mask was

delivered to patient each month,
How many TB suspected was
send directly to doctor
Review infection control of
visiting patient room every
quarter

4|Page

SMART MONITORING TA PLAN round 1 (August 2014)

USAID/SMART TA

No Xray box at the OPC

No Xray storage for TB suspected
patient

No Air condition in drug storage

CASE MANAGMENT

Action: Discuss with doctor and reception

nurse every quarter for infection control
Fix:
Buy and placed Xray Box at
Doctor room
Reception nurse keep Xray result
for review at OPC
Fix:
Repaired or replaced by District
Health Center (DHC)

Treatment
doctor
Treatment
nurse (Hien)

Luong Hau Tan

OPC chief

Luong Hau Tan

(deputy of DHC)

Plan: Improve case management

Do:

Poor case management

Apply E-logbook tool to monitor

delay/missed appointment
patient
Use LTFU screening tool to
screening patient who have high
risk of LTFU or poor adherence
Create the case management
logbook and follow-up by case
manager (counsellor)
Send special case to CHBC for
home visit and counseling when
needed

HBC team
and
counsellor

SMARTA
Duc Anh

September,
2014

PDSA 4

OPC chief

September,
2014

PDSA 5

Study: OPC chief review the case

management logbook every month
Action: Discuss with case manager and
HBC team monthly to improve case
management
2

Not follow-up on referral case

Plan: Follow-up and record all referred

case

HBC team
and

5|Page

SMART MONITORING TA PLAN round 1 (August 2014)

USAID/SMART TA

counsellor
Do: Reception nurse write all referred
case to logbook and call patient to
confirm about their status. If the logbook
is empty or unconfirmed about the
patient status, contact HBC to visit patient
and send to case manager
Study: Keep documenting the log book of
referral case
Action: Case review of each unconfirmed
or unsuccessful transfer by clinical team
at end of month to improve process
G

ART and pre-ART service delivery

Low of retention rate

Patient chart lack of patient

photo and identification
document

See the PDSA 4

Fix:

Complete chart as required

Hien review and list all LTFU,

Dead patient chart in the end of
working day
Dr Thuc/Quoc write summaries
on chart
Hien keep separately LTFU/Dropout patient chart

OPC chief
and
reception
nurse

HBC team

September,
2014

Hien
(treatment
nurse)

Fix:

No doctor summaries on LTFU

and dead patient chart

Hien
(treatment
nurse)
OPC Doctor

September,
2014

6|Page