MODEL OF GOOD CARE

By:

Dr. Suhazeli bin Abdullah,

Family Medicine Specialist,

Klinik Kesihatan Permaisuri

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What is MOGC?

Variation in healthcare delivery To follow the best practice available Element of Evidence-Based Medicine Provision of protocols & guidelines.

Management Protocol CPG SOP

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ABNA concept

0

25

50

75

100

With unlimited resourceideal level of care

Optimal Achievable Level

- targeted level within means

ABNA:difference between OA & achieved levelQA aims at narrowing or

eliminating this gap

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ABNA}

Ideal

Optimum

Actual

Recap….

3

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To reduce magnitude of ABNA

Eliminate or minimized○ Error of omission○ Error of commission

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Process of Care MoGC

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PROCESS OF CARE

Processes is the steps in healthcare activities the workers- should undertake - get information about- should record - do when diagnose, treating, follow-up

The steps is adopted from professionally accepted standard of norm, SOP, guidelines, circulars, CPG & …….

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FLOW CHART SYMBOLS OVAL / CIRCLE

INDICATES THE FIRST & LAST

DIAMOND SHAPE REPRESENTS A DECISIONPOINT

RECTANGLE REPRESENTS A PROCESSING STEP

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CARTA ALIRAN ASAL PENGENDALIAN KES IBU BERSALIN DI PBBR, HTAA

Pendaftaran masuk di PAC

Saringan di buat oleh Jururawat y/m mengikut

checklist

Risiko Tinggi

Di masukan ke Dewan Bersalin

Risko Rendah

Pemeriksaan ibu dan janin di Pusat

BersalinBermasaalah

Tidak bermasaalah

Bersalin di PBBR

Penjagaan ibu dan bayi di postnatal

DISCAJ

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MODEL OF GOOD CARE

STEP NO

PROCESS OF CARE

CRITERIA

STANDARD

A B C C1 C2 C3 D

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CONTOH: Proses kerja MOGC bagi mendapatkan laporan perubatan

PROSES Buat permohonan

+ bayar Trace BHT Beri Dr untuk

deraf report Deraf } Taip } Tandatangan } Beri kepada

pemohon

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MASA SEPATUTDIAMBIL

1 hari

1 hari

3 hari

2 hari

] JUMLAH MASA ] YANG] DIPERLUKAN

] < 1 minggu]]

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Proses mendapatkan laporan perubatan sebenar

Buat permohonan + bayar

Trace BHT Beri Dr untuk deraf

report Deraf ] Taip ] Tandatangan ] Beri kepada

pemohon

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MASA TELAH DI AMBIL

1 hari

5 hari } }

5 hari } } }8 hari }

}2 hari }

JUMLAH MASA YANG

DIPERLUKAN

> 3 minggu

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No. Process Criteria Standard1.

Registration Address Time of registration Educational status

< 12 / 52 90 %

*2.History Taking LMP Age Parity Family History Past Obstetric History History

Conduct / TBA PE IUGR LSCS

Past gynae history Past medical history

1 x / pregnancy(During booking)

100 %

Symptoms of eclampsia Every ANC visitEvery Home visit

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*3.Physical Examination Height Weight BP Pallor Thyroid Fundus Abdomen

1 x / pregnancyEvery visit

100 %

*4.Lab Investigation Urine : Sugar , Albumin Blood group + Rh

Every visit100 %

*5.Managementa. Mild PE Refer M&HO (Rx

protocol)b. Severe PE Refer hospital

All casesAll cases

100 %

*6.Follow-upa. Antenatal clinicb. Home visit

Weekly2x / week

90 %

7.Health education Advice

100 %

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MODEL OF GOOD CARE

No. Process Criteria Standard

1. Admission Room

Registration & Clerking

Identification of risk factor for low A/S

CTG

Case should be attended within 30 minutes

Risk factors identified

Prompt CTG for high risk cases

100 %

100 %

100 %

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No. Process Criteria Standard

2. Antenatal Ward

Fetal well being

Maternal monitoring

1. CTG for all high risk cases

2. FKC for all cases

3. FH monitoring for all cases

4. U/S for high risk cases

1. V/S for all cases

2. Education for all cases

100 %

100 %

100 %

100 %

100 %

100 %

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No. Process Criteria Standard

3. Labour roomReassessment of risk factor

Partogram

CTG

Identify risk factor for low A/S

Effective use of partogram

External CTG for all patient at least onceInternal CTG for all high risk cases

100 %

100 %

100%

100 %

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MODEL OF GOOD CARE

Proses kerja Kriteria Standard T/jawab

1. Pendaftaran ke PBBR,HTAA

Mengikut garispanduan dan checklist ABC KKM 100% J/M

2. Pemeriksaan pesakit 1. Mengambil riwayat pesakit

2. Pemeriksaan fizikal / vagina

100% J/M

3. Intrapartum 1. Pathogram setiap 4 jam

2. Pemeriksaan kontraksi ibu dan denyutan janin

100% J/T atau J/M

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4. Kelahiran normal 1. Ibu di beri suntikan syntometrine2. Placenta di keluarkan mengikut CCT3. Darah cord di ambil untuk G6PD4. Bayi di bersihkan secara top & tail5. Bayi di beri tag yg sama degan ibu6. Pemeriksaan fizikal bayi dibuat

mengikut checklist7. Bayi di beri kepada ibu dalam tempoh

< 30 minit

100% J/T atau J/M

5. Postpartum 1. Pemeriksan fizikal ibu dan bayi2. Kaunseling penyusuan bayi,

perancantg keluarga,pemakanan sihat dan penjgaan postnatal

90% J/T atau J/M

6. Discaj 1. Penyediaan bil2. Temujanji di Pusat Kesihatan yang

berdekatan100% J/T atau J/M

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INDICATOR

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indicator

An INDICATOR is a measurable variable (data) relating to structure, process or outcome

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GENERAL indicator

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clinical indicator

an instrument (DATA) used to assess a measurable aspect of patient care

acts as a guide to assessing the performance of a hospital, department or individuals within it.

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choosing indicator

Nosocomial Infection Rate

BOR as an indicator of bed utilization

Kelewatan menghantar kes-kes rujukan kecemasan.

Kadar pembatalan temujanji pesakit luar

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choosing indicator

Peratusan Ibu Hamil Mendapat Rawatan Pergigian

Kadar “Reject” Filem X-Ray

Kadar Penggunaan Botol Spesimen Yang tidak Betul

Kadar Kehadiran Tindak Susul Selepas program Saringan CVD.

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STANDARDS

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standards setting

1. Literature2. Other studies3. Consensus4. Arbitrary

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Standards Setting

Setting too high a standard may make the problem unsolvable and the target unreachable

If its too low, it may not reflect quality level of care that’s acceptable

Use literature and other studies to determine the appropriate standard in YOUR setup

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standards setting

Or set standards after knowing current level of care Only useful data

When human factors are involved usually the standard should not be 100%

(It can be absolute if the factor or problem is seen to be very important)

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Indikator Bil. Ibu Hamil Anemia X 100 Jumlah

ibu Hamil pada 35 – 36 minggu

Standard standard yang akan dicapai bagi tahun

2004 adalah 25%

INDIKATOR & STANDARD INDIKATOR : adalah peratusan jumlah kes berisiko

rendah bersalin di PBBR mengikut garispanduan iaitu

STANDARD : Peratusan yang bersalin di Pusat bersalin adalah tidak kurang daripada

12 % JUMLAH KESELURUHAN KELAHIRAN DI HTAA

Jumlah kes berisiko rendah bersalin

Jumlah kelahiran di HTAA 100 %

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CRITERIA

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Criteria

Conditions to fulfill or to define an indicator or a variable/sample

In simple words are DEFINITIONS or PREREQUISITES of a term

May be tied to a STANDARD Can be used to define the sample limits

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Inclusion Criteria

Criteria of study subjects that is to be included in data (sample to be collected)

not clearly defined by indicator or title

List should not be too long

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exclusion criteria

Subjects to be excluded from study

Limits sample size to relevant

subjects

Smaller number to study

Data collection easier and

manageable

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criteria

MENINGKATKAN KEHADIRAN IBU HAMIL MEMDAPATKAN RAWATAN PERGIGIAN.

1. Kehadiran Ibu Hamil bermaksud ibu mengandung yang menghadiri Klinik Antenatal datang mendapatkan rawatan pergigian.(kriteria)

2. Kehadiran bermaksud datang untuk mendapatkan rawatan pergigian (definasi)

3. Kehadiran ibu hamil untuk mendapatkan rawatan pergigian apabila dirujuk oleh kakitangan KKIK. (Inclusion criteria)

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Pengurangan Peratus Anemia Dikalangan Ibu Hamil Pada Usia Kandungan 36 Minggu Di Daerah Setiu

Inclusion Criteria Semua ibu hamil yang datang ke Klinik ibu dan anak semasa tempoh

kajian. Mereka yang mengalami anemia di Daerah Setiu selain dari kriteria tertentu yang disisihkan seperti dibawah.

Exclusion (Kriteria yang yang disisih) Semua ibu hamil yang disahkan mengalami penyakit perubatan yang

seperti Thalasemia, Luekemia dan Haemophilia. Pesakit yang memerlukan perawatan segera ke hospital seperti

anemia yang teruk dan memerlukan pemindahan darah. Pesakit yang mengalami komplikasi dari perdarahan, eklampsia dan

kencing manis yang teruk Kes lewat “booking” akibat dari kes luar yang mahu bersalin di

kampung halaman. Kes yang mungkir temujanji melebihi dua (2) kali berturut-turut.

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