SMART MONITORING TA PLAN

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

Jan 2014

to

June 2014

25 August 2014
MMT & Care and treatment, HIV testing in MuongCha District (Opened in 2012)
Services provided

ARV Adult
ARV Pediatric

HIV testing

MMT (GF)

PMTCT

HBC

Out-reach

TB

STI

Regional character

City

Urban

Mountainous

Patient in prison/detention center

Ethnic minority

Other character

90

Patient managed:
Key OPC staff

Tittle

Le Quang Chung
Pham Van Tuyen

3.

Phan Thi Lai Thanh

4.
5.
6.

Lu Thi Dung
Luong Thi Dung
Vu Thi Hien

7.

Lu Thi Nhieu

8.
9.
10.
11.
12.
13.
14.
15.

Lo Van Than
Lo Thi Chien

OPC chief
Treatment doctor
Administrative
officer
Reception nurse
Pharmacist
Pharmacist
VCT counselor and
lab test
Peer HBC
Peer HBC

Total
Project monitor
USAID/SMARTA

( (% Total client)

102

Name
1.
2.

(% Total client)

OPC chief

Part-time
(GVN staff)
X
X

PAC representative

Full time
contracted

X
X
X
X
X
X
X

Assessment data file

File nh gi d n
USAID/ SMART TA

Bs. Nguyn c Anh

BS. Le Quang Chung

Nguyn Thin Hng

(P. CSDT)

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USAID/SMART TA
Assessment content

Result

Human resource

Data structure and

assessment

56%

Drug supply

90%

Lab capacity

80%

Data control

70%

Case management

0%

Service delivery (ART/ preART)

80%

Human
resource

75%

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

Service
delivery
(ART/ preART)

Case
managemen
t

Data
structure
and
assessment

Drug supply

Data control

Lab capacity

SMART MONITORING INDICATOR AND HIVQUAL RESULT

Microsoft Excel
2003 Worksheet

TT
1
2

3
4
5

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
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

1/4/13 30/9/13

1/10/13 31/3/14

Last result

Current
result

Diff

Score

80%

100

75%

76

75%

75

80%

71

85%

92

Smart
monitoring
indicator

Smart
monitoring
indicator

proportion of patient were adherence

assessment in the last visit

95%

98

Proportion of eligible clients initiating ART

within 30 days during the past 6 months

75%

93

Proportion of patient were CTX prescribed

90%

80

Proportion of patient were TB screening at the

last visit

80%

97

10

Proportion of patient had CD4 testing every 6

month

85%

87

11

ART retention after 12 months of starting ART

85%

83

12

Retention rate after 12 month of registration

85%

72

Classified

Smart
monitoring
indicator
Smart
monitoring
indicator

SMART monitoring score

Notes

Smart
monitoring
indicator
Smart
monitoring
indicator

4
Improving

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USAID/SMART TA

TT
B

Issues

QI activities

Responsible

Supporter

Deadline

Note

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

September,
2014

PDSA 2

Study: OPC chief interview all staff on

understanding of universal precaution
every three month
Action: Respond to staff feedback
Plan: Counselor use chart and job aids
when giving counselling

Lack of Job aids for patient

counseling

No fast examination for TB

active/suspected

Do: SMARTA send 2 set of patient

counselling picture book to OPC for
patient counselling
Counselor

SMARTA

OPC
treatment

SMARTA send
instruction of

Study: Interview with staff to confirm that

job aids are available, understandable,
and use frequently
Action: OPC chief is monitoring the use of
job aids in counseling service provided
Plan: Implement the examination for
TB/TB suspected patient, improving

PDSA 3

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USAID/SMART TA

infection control
No spit/cough instruction at
patient waiting area

Do:

Study

5
F
1

No Xray box and keep Xray result

No open-close time announced at

OPC name board and the board
also damaged
CASE MANAGMENT

doctor and
reception
nurse

cough/spit to
OPC.

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

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

Action: Discuss with doctor and reception

nurse every quarter for infection control
Fix:
Buy and placed X Ray box at
examination room
Administrative office keep
patients Xray result for review
later

OPC chief

SMARTA
Thanh OPC
(admin officer)

Fix: OPC chief making plan for repair

OPC chief

SMARTA
Thanh OPC
(admin officer)

Plan: Improve case management

HBC team
and
counsellor

SMARTA
Duc Anh

Weak case management

Do:

September,
2014

PDSA 4

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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

Study: OPC chief review the case

management logbook every month
Action: Discuss with case manager and
HBC team monthly to improve case
management
Plan: Follow-up and record all referred
case

Not follow-up on referral case

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

HBC team
and
counsellor

OPC chief

September,
2014

PDSA 5

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

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Low of retention rate

See the PDSA 4

OPC chief and

reception
nurse

HBC team

September,
2014

OPC
treatment
doctor

Thanh (Admin
officer)

September,
2014

OPC
treatment
doctor

Thanh (Admin
officer)

Plan: Increase the INH prescription up to

70%
Do:

Low of INH prescription rate

2

Doctor wait up to 6 month after

ARV initiated to prescribe INH

Doctor give INH prescription for

patient who after 1 month of
ARV initiated
Screen all patient chart for INH
prescription: Put red sticker on
chart not yet on INH
With INH completed chart, write
notice on the chart summary

PDSA 6

Study: Review all red sticker chart

monthly
Action: Doctor check the patient chart to
review INH prescription every time
patient examination
Plan: Send sample patient, not sending
patient
Do:

Patient have to travel for

GeneXpert test

Discuss and has agreement with

TB unit to collect patient sample
and send sample for the test
Record all patients who are
referred, number get smear,
number who get genexpert,
number positive with each

Study: Record all of GeneXpert case and

follow-up

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USAID/SMART TA

Action: OPC doctor and Mrs Thanh will

follow-up all case of TB diagnosis referral

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