Improving the quality of care for sick children WHO Hospital Care for Children

1. Improving the quality of care for sick children WHO Hospital Care for Children

2. Why do we need guidelines for treatment? • Scope for improving the quality of care for seriously ill children in hospitals • Most care for sick children is done by nurses or non-specialist doctors • Standardized clinical care is most efficient • Need benchmarks for identifying where care can be improved • Resources (drugs, equipment) • Skills and knowledge of clinical staff • Systems and organisation • WHO Standards for other aspects of care

3. Pocket Book of Hospital Care for Children • First edition 2005, second edition 2013 Children may present with one complaint, but have several illnesses. • New WHO standards for improving the quality of health care for children and adolescents (2018)

4. Stages in the management of a sick child • Triage • Emergency treatment • History and examination • Laboratory investigations • Main diagnosis and other diagnoses • Treatment • Supportive care • Monitoring • Discharge planning • Follow-up

5. Layout of Pocketbook • Chapter 1: Triage and Emergency conditions • Emergency • Priority • Chapter 2. Diagnostic approach to the sick child • Syndrome based • Differential diagnosis • Simplified for settings without specialised staff • Chapter 3. Problems of the neonate and young infant • Chapter 4. Cough or difficult breathing • Chapter 5. Diarrhoea • Chapter 6. Fever

6. Layout of Pocketbook • Chapter 7. Severe malnutrition • Chapter 8. Children with HIV/AIDS • Chapter 9. Common surgical problems • Chapter 10. Supportive care • Chapter 11. Monitoring the child’s progress • Chapter 12. Counselling and discharge from hospital • Appendices • Procedures • Drugs • IV fluids • Assessing nutritional status • Job aids and charts • Toys and play therapy

7. Charts that describe emergency management

9. Signs and severity of pneumonia

10. Examples of x-ray changes

11. Chapter 11 – Monitoring and response chart • Patients details • Vital signs • Fluid balance • Clinical signs, complications and findings • Treatments • Feeding/ nutrition • Outcome

12. Paediatric monitoring and response chartHospital:Name: Age: Weight: UR number: Frequency of observations:

13. Appendix 1. Practical procedures e.g. insertion of chest tube

14. Appendix 2: Table of drug dosages

15. The Training Course • Aims to teach health workers how to use the Guidelines in everyday clinical practice • Clinical cases illustrate each chapter • PowerPoint presentation • Photographs, diagrams and videos illustrating important clinical signs and procedures

16. The course structure and aims • Stages in the management of a sick child : • Triage • Emergency treatment • History and examination • Laboratory investigations, if required • Diagnoses (main and secondary) • Treatment • Monitoring • Supportive care • Discharge planning • Follow-up

17. The training methodology • Problem-based cases introducing the Guidelines chapters • Clinical practice on how to use the Guidelines in everyday paediatric care (work on the children’s ward) • Focus on the major problems identified in local quality of care surveys • Discussions about improving quality of care and problem solving

18. The training methodology • Participatory • Interactive • Clinically based • Don’t worry about not knowing something! • Have fun!

19. Russian Portuguese French Also… Chinese Turkish Spanish Bahasa Indonesian Vietnamese Armenian Albanian Turkmen Laotian Dari (Afghanistan) Mongolian Uzbek www.hospitalcareforchildren.org

20. Solomon Islands First Hospital Care for Children courseHoniara, 2004

21. Solomon Islands 2005-11 Provincial workshops

22. 2002-04 Kazakhastan and Uzbekistan

23. 2007 Indonesia

24. 2009-11 Lao PDR

25. 2010 Fiji and Pacific Islands

26. 2011 Kimbe Hospital, Papua New Guinea

28. 2015 Mt Hagen Hospital, Papua New Guinea

29. Summary • The WHO Pocketbook and PNG Standard Treatment Manual are evidence-based guidelines for the management of all common conditions of children • Requires a minimal amount of essential drugs and basic laboratory facilities • New WHO Standards of care • Comprehensive care, all the stages, not just drug treatment • Have fun in the course!