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Using the Supervisory Checklist

Using the Supervisory Checklist. Module 9 Part B. How do I monitor?. The supervisory checklist gives you a structure you can use … … but it should not limit what you look at There are further steps to take to interpret the data and get a complete picture. The Supervisory Checklist.

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Using the Supervisory Checklist

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  1. Using the Supervisory Checklist Module 9 Part B

  2. How do I monitor? • The supervisory checklist gives you a structure you can use … • … but it should not limit what you look at • There are further steps to take to interpret the data and get a complete picture

  3. The Supervisory Checklist • Take a look at the supervisory checklist • Understand the scoring system • We’re going to look at three important parts of the checklist: • Suspect and Sputum Dispatch Register • TB Facility Register • Treatment Card

  4. The Supervisory Checklist • Scoring System • 0 Not Done • 1 Poor • 2 Satisfactory • 3 Good

  5. The Supervisory Checklist • Scoring System • 0 Not Done • 1 Poor • 2 Satisfactory • 3 Good • Per Quarter • Entry not completed • <75% complete • >=75% complete • >= 90% complete

  6. The Suspect and Sputum Dispatch Register • Regularly Used: All Registered TB cases found in SSD; additional unconfirmed Suspects also in SSD; SSD used for registering f/up exams. Good= On average, 90% of confirmed cases and f/ups logged in. • Columns complete: Good= On average, 90% of columns completed. • Suspects have 3 Sputums. Good= On average, 90% suspects have 3 specimens logged in. • Results Correctly Recorded. Good= On average, 90% of logged entries have results for all specimens recorded as N or P with a grade 1+ 2+ etc.

  7. Three sputum smears examined? • Level of knowledge: • Do the HCWs understand the need for three sputum smears? • Attitude / Perception • Do they care? Are they interested in complete, quality data? • Seeking guidance • Do they have questions?

  8. Checklist: The TB Register

  9. Is the Register Complete? • Level of knowledge: • Do the HCWs understand what each column is for? • Attitude / Perception • Do they care? Are they interested in complete, quality data? • Seeking guidance • Do they have questions?

  10. Checklist: The TB Register • Confirmed ases registered (compared to Lab Reg and SSD) • Good= On average, 90% of confirmed cases registered. • Pt Information complete: Good= On average, 90% of columns completed. • Sputum results recorded. Good= On average, 90% suspects have correct number of specimens AND results recorded • Compliance correctly recorded. Good= On average, 90% of doses to date recorded and signed

  11. Checklist: The TB Register • Treatment outcome recorded correctly: Cured or Completed based on presence of bacteriology results. “DISCHARGED” IS not AN OUTCOME! Good= On average, 90% of confirmed cases registered. • HIV results recorded: Good= On average, 90% of columns completed as positive OR negative. • IPT History recorded. Good= On average, 90% of HIV+ cases have been asked whether they ever received IPT & date started • ART status: Good= On average, 90% of HIV+ cases have been asked whether they are on ART &date started.

  12. All Sputum Results Recorded? • Level of knowledge: • Are the HCWs familiar with 1+, 2+ etc.? • Attitude / Perception • Do they know that microscopy is essential for diagnosis? • That follow-up is essential for patient monitoring and documenting cure? • Seeking guidance • What do they need to understand to do their job better?

  13. The comments column:Why is this important? Dropped from 95% in last supervision to 20% in this supervision. 1 DOT Workers report that they do not understand how to use the form and are too busy to do it. 1 • What does the score tell you? • both activities are poorly done This is your chance to be heard. • What do the comments tell you? • Something caused a sudden drop in indicator 1 • DOT workers need training

  14. Checklist: Patient Treatment Card

  15. Communication with DOT Workers

  16. Some communication tips (2)  • DO’s: • Listen and be prepared to learn • Give the person space and time to answer • Be tactful and discrete • Talk to as many people as possible (at all levels)  • DONT’s: • Don’t “lead the witness” – ie don’t try to get the answer you want to hear • Don’t overreact to a negative verbal report. First check against the data, then form an opinion.

  17. Planning the supervision visit

  18. Logistics • Make a list of all the facilities in your district • - Include the name and cell phone number of the Matron and TB Focal Person • 2. Group them by location/region • Facilities in the District capital where you work and reside will be the busiest and the easiest to visit, so • Plan your visits to outlying areas first • Schedule local facility and lab visits next

  19. Scheduling supervisory visits For example, split the district into sections and visit different regions on alternate weeks

  20. Supervisory Visits • Confirm the dates with the TB Focal Person or Matron before arriving • Provide explicit expectations • Are treatment cards organized and complete? • Is register up-to-date? • Have they made a list of things requiring your follow-up? (e.g., transfers) • Listen and note problems or issues they are experiencing (e.g., test kit shortages) • Offer to bring needed supplies

  21. Checklists and Reminders • Checklists and reminders are a good visual aid • Should be clear and concise, strategically placed • Well-designed and visually pleasing

  22. Communication about next steps / debriefing

  23. Some communication tips (3)   • DO’s: • Follow any lead you are given • Report back on what steps can / should be taken • Encourage internal discussion and try to “facilitate” a solution • Identify experienced people and draw from their experience • DONT’s: • Don’t dismiss anyone’s concerns • Don’t worry if you don’t have an immediate answer. You might need to talk to lots of people. • Don’t take anything at face value. Check against the data!

  24. Exercise 9.1 • Working alone, review the sample suspect register worksheet • Answer questions 2-4 on your handout • Faculty will assist

  25. Exercise 9.2 • Using the handout, review the register and make note of any possible problems in recording and reporting • Enter a score and your findings into the supervision checklist • Discussion

  26. Exercise 9.3 • Based on your observations and analysis in the previous exercise develop follow-up checking questions for the following indicators in the supervision checklist: • Patient’s attendance is correctly recorded • Patient’s information is complete • All HIV Status results are correctly recorded

  27. Exercise 9.4 • Working in groups, and using the patient register, calculate the following indicators: • AFB Diagnosis Rate • Program Default Rate • Sputum Conversion Rate • Proportion of notified cases tested for HIV • Enter your findings and interpretation into the supervision checklist

  28. Exercise 9.5 • Working in pairs, review the sample treatment cards • Calculate % of patients who received all treatment under DOT • Review quality of recording and reporting • Enter a score into the supervision checklist, along with comments • Faculty will assist

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