- To reduce client`s waiting time from over 4hrs to less than 45mins from entry to exit points.
- Stable clients identified by review of files. Exit interviews conducted randomly for stable clients to establish the time taken and average time found. This was done by use of time recorder and the results are as below.
|
month
|
March
|
April
|
May
|
|
No of clients interviewed
|
23
|
19
|
25
|
|
Cumulative time taken
|
91
|
81.7
|
97.5
|
|
Average time/hrs to nearest whole number(4.06hrs)
|
4
|
4.3
|
3.9
|
The clinic team identified the above issue, as one of the factors causing a gap in client retention into care which reduces the efficacy of good ART program.
The QI site team planned activities to reduce the benching time and improve on clients’ appointment keeping, reducing the challenges of poor adherence to therapy and improving clients` clinical outcome.
CHANGES INTRODUCED
Pre-packing drugs
Drugs are pre-packed before the clinic day/before clients reach the dispensing widow i.e. every evening and early in the morning on each clinic day, to reduce time spent at pharmacy. The pre-packing is done by clinic Volunteers and nurses to ease the workload on the clinic day. This resulted in completion of clinic work by 4pm.
Task shifting
These include review of roles and responsibilities of the clinic team members. Files for clients for scheduled appointment days are retrieved on previous day, and triage team helps in sorting out the clients according to their stability (wellness).Nurses took on some clinician `s roles especially reviewing stable clients. This was implemented after Nurses were trained in clinical management of HIV positive stable clients, mentoring and regular support supervision by medical clinical offers and M/Os helped the team to perform their duties diligently. This change led to an improvement in reduction of client waiting time in the clinic.
Involving patients in quality improvement
The clinic team works closely with expert clients in the clinic. They are involved in giving daily health education on positive prevention attitudes to clients, tracing of clients who miss their appointment dates over 7 days as well as offering day care for the children. This brought a sense of relief and satisfaction on the part of the patients and improved patient-provider relations.
More than a months’ supply of ART
This was the most significant change that helped patients with transport and distant challenges. This change was applicable to stable clients, with good adherence to their therapies, no history of missed appointments and no chronic conditions such as Diabetics and hypertension. The success of this change has been attributed to availability of sufficient drug stocks.
Introduction of time –appointments:
Clients were given chance to discuss with the clinical team during consultation session to choose a convenient time to come to clinic, such that, they are booked for clinical consultation on that particular time, e.g. 10:00 am.3:00pm, this change worked well with working class patients to help them to reduce long benching hours in the clinic , It has helped clients with high stigma to keep their appointment dates.
