From the HIVQUAL International Update:

Al Nouri Specialist Hospital, Kano: CD4 Monitoring

Al Nouri Specialist Hospital, a treatment partner of AIDS Relief, is located in Kano, northern Nigeria. As of July 2009, approximately 2288 patients had received HIV care services, of which 1188 received ART.

To jump start their improvement program, Al Nouri established a quality management committee comprised of five staff, including the ART physician, three nurses, and a pre-existing M&E representative. Through facility partner AIDS relief, a June 2009 quality training provided valuable educational support for a member of the QI team. Monthly meetings were established to review QI activities.

When baseline data revealed low performance in CD4 monitoring (% of patients from chart reviews with CD4 repeat at 6 months within the month), hospital staff chose that aspect of care as their QI focus. On HIV clinic days, the team used morning health discussions as a resource to implement patient education about HIV and stress the importance of CD4 monitoring. The team also used weekly clinic meetings to reinforce the importance of CD4 monitoring among physicians at the hospital. Al Nouri’s improvement team asked nurses to flag patient charts to establish reminders for follow-up CD4 count. The nursing staff was also asked to request CD4 counts immediately after completion of vital signs during patient visits, and prior to meeting with a doctor. To reduce no-shows and redundancy, doctors took responsibility for coordinating clinical appointments with dates of CD4 testing. The team tasked the lab with identifying and returning all poorly filled out lab forms.

Staff now understand that goals can be achieved through small changes, and documentation of progress within short time frames promotes continuity within the quality program. The team remains focused on their improvement goals, and is prepared to shift activities if measurement demonstrates that a particular strategy is not working from one round of data to the next.

HIVQUAL software will continue to improve data reporting, supported by HIVQUAL coaching to enhance performance and success of the QI activity.

COUNTRY PROFILE:  HIVQUAL-Nigeria Speeds Ahead in First 18 Months

In July 2007, HIVQUAL-Nigeria shifted into high gear with a series of high-level meetings between the Nigeria Federal Ministry of Health, CDC-Nigeria and HIVQUAL. Meetings were held to gain support and involvement from the National Guidelines Committee, key stakeholders, partner organizations, providers, and patients living with HIV/AIDS. With strong support at the national level, plans moved ahead quickly in the following weeks with the development of indicators, initiation of training sessions for key FMoH, CDC and facility staff, and data collection activities. 
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