ClASS MODULES: BREAKOUT SESSIONS

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ClASS MODULES: BREAKOUT SESSIONS. ClASS CLINICAL MODULE. Session Objectives . By the end of the session, participants will be able to: List the 10 content areas within the ClASS Clinical Module Describe the structure and organization of the ClASS Clinical Module - PowerPoint PPT Presentation

Text of ClASS MODULES: BREAKOUT SESSIONS

CLINICAL ASSESSMENT FOR SYSTEMS STRENGTHENING (ClASS)

ClASS MODULES: BREAKOUT SESSIONS

We will now break into groups so that you will have the opportunity to closely review and work with the module that you will actually work with as a ClASS Reviewer. If you are eligible and/or interested in working with more than one of the ClASS modules, for the purposes of this training, please choose the one that is most relevant to your expertise. 1ClASS CLINICAL MODULE

HAND OUT ClASS Clinical Module to participants so that they may refer to it as you facilitate the session.

Time allotted for review of the tool, discussion, and Q&A (slides 1-9) is 45 minutes. Time allotted for the activity and key points (slides 10 and 11) is 60 minutes.2Session Objectives By the end of the session, participants will be able to:List the 10 content areas within the ClASS Clinical ModuleDescribe the structure and organization of the ClASS Clinical ModuleExplain how the tool may be used in its modular formatIdentify key resources from which to gather informationDevelop a plan for gathering information on-siteEffectively present findings and recommendationsREAD the objectives and ask participants if they have any questions before moving on. ASK participants to introduce themselves and to share what they hope to get out of the breakout session. WRITE these responses down on a flip chart to be sure they are addressed during the session.

3Section 1: Facility, Staffing & ServicesSection 2: Clinical Care & Oversight ManagementSection 3: Infection ControlSection 4: Maternal, Infant, Child Health & Pediatric HIV ServicesSection 5: Referrals & Access to Relevant ServicesSection 6: Pharmacy & Supply Chain ManagementSection 7: Quality Improvement &Performance MonitoringContent Areas (1)The first thing to note about the ClASS Clinical Module is that its a guide, not a checklist, for reviewers conducting assessments of health facilities or programs providing patient care services.

The module is divided into 14 sections. The first 10 sections have been used for assessing the comprehensiveness and quality of services provided at treatment sites or programs, and the last four for assessing the ability to provide clinical technical support and oversight to beneficiary organizations. Even within these categories, reviewers will find that not all sections of the tool will apply to all types and levels of facilities being assessed. An important feature of the ClASS Toolkit is that it is modular in format, which means that the review team, in conjunction with collaborating partners, may choose to use only those modules or sections of modules that are most relevant to the needs of the organization being assessed.

4Section 8: Laboratory & Other Diagnostic ServicesSection 9: Client/Patient Involvement in CareSection 10: Health Management Information SystemsSection 11: Clinical/Technical CapacitySection 12: Clinical/Technical Support ApproachesSection 13: Clinical/Technical Support OutcomesSection 14: Ongoing Program Support: Critical Gaps and Technical Assistance Needs

Content Areas (2)Areas of competency have been linked with references, wherever possible, with WHO and other international standards or best practices in clinical care and treatment. Reviewers should also always reference local National standards for each country in which an assessment occurs to see if their guidelines/standards differ in any way.

ASK if there are any questions before advancing to the next slide.

5Other Support ToolsAdult Chart ReviewPediatric Chart ReviewPMTCT Chart Review

The adult chart review focuses on whether or not the clinical records contain sufficient and updated patient information; sufficient documentation to justify diagnosis and treatment (testing and lab results specific to an adult patient) ; enrollment and follow-up data and overall whether the information can be retrieved as needed.

The pediatric chart review focuses on whether or not the clinical records contain sufficient and updated patient information; sufficient documentation to justify diagnosis and treatment (testing, lab results) and therapy specific to the treatment of a baby or child) ; enrollment and follow-up data and overall whether the information can be retrieved as needed.

The PMTCT chart review focuses on whether or not the clinical records contain sufficient and updated patient information; sufficient documentation to justify treatment (pre-partum HIV diagnostic tests and baseline clinical data) ; enrollment and follow-up (post-partum) data and overall whether the information can be retrieved as needed.6Structure and Organization (1)

Each section begins with a set of core competencies followed by a series of questions that can be used to facilitate discussions with organization representatives. Verification criteria for the most important core competencies and questions follow along with space for reviewers to make notes. Reviewers should not feel compelled to complete the tool sections in the order presented, but should proceed with flexibility to accommodate the time and availability of staff.

You can see from the example on this slide here how core competencies, questions and verification information are organized in the tool. These are truncated so that they may be viewed on the slide. Please refer to section 1 of the tool to see the full sets.

GIVE participants a few minutes to look through the module (approx 5 mins).TAKE a few minutes to clarify any questions before moving on (approx 5 mins).7Structure and Organization (2)

Tool contents are based on the assumption that there will be at least six hours available to reviewers at each site. When time is more limited, reviewers should determine which sections to prioritize. In such a rapid visit, the highlighted competencies in the various sections should be addressed; these items are denoted in bold-face type. The choice on which sections to prioritize should be made after the opening presentation and in consultation with the team lead.

Also, you should note that while Section 10 covers the key HMIS core competencies, it should also be accompanied by a review of the patients medical records. Additional tools for conducting a systematic chart review for adult, pediatric and PMTCT clients are provided. The reviewer should decide on an appropriate number of charts for review to get a good understanding of both cross sectional and longitudinal care and a quick determination of the quality of documentation and overall quality of care. Where time does not allow a systematic chart review, a detailed review of two or three charts should be done focusing on continuity of care and level of documentation.

ASK if there any questions before advancing to the next slide.

8Document ReviewAdvance ReviewOn-Site ReviewList of HIV care providers and roleAll Clinical Protocols and standard operating policies and procedures (including reproductive health and family planning).Opening and closing hours policyPatient Registers, patient medical charts and other monitoring forms.Infection control policies and proceduresPatient Consent Policies and Forms.HIV counseling and testing policiesPharmacy ledgers.Pharmacy Policies and SoPsPatient referral policies, directory and tracking formsPatient Satisfaction Surveys tools and most recent Survey ResultsContinuing medical (professional) Education Attendance Records and or Proceedings.Emergency care policies and proceduresTrainings clinical staff has participated in last 12 mo.National HIV Care and Treatment Guidelines (Adult, Pediatrics, PMTCT, HCT, and etc.)Laboratory policies and standard operating procedures for absolute minimum tests (HIV antibody test and hemoglobin), basic tests (white blood cell count, serum creatinine, a serum glucose, and pregnancy tests), and (CD4).Quality improvement and assurance plan, protocols and committee minutesPolicy documents on post exposure prophylaxis Laboratory QA and QC reports.Continuous Quality Improvement reports (STOCS/PDSA)

Clinical charts (adult, PMTCT and pediatric HIV care and treatment) This is an example of the list of documents requested for the ClASS Clinical assessment. This list is truncated so that it fits on the slide, but you may find these tables on pages 47-51 in the ClASS Assessment Guide which is in your manual, and also available at www.classtoolkit.org. Well talk about exactly how/where to locate this and other resources in an upcoming session).

Note that it separates the documents list into 2 columnsdocuments that should be sent in advance of the assessment and those that are typically reviewed on-site. The exact list may vary depending on the organization.

REVIEW the list and discuss how you might use information from these documents to inform your review. Highlight the documents you find most helpful. Which ones do you just skim?

ASK if there any questions before advancing to the next slide.

9Key Staff Interviews

This table provides a list of key staff to be interviewed for each module during a clinic site assessment. This table is included on page 41 of the ClASS Assessment Guide. Please note that if you are assessing a MEPI or NEPI-related program, this list will look different, and may vary depending on the type of organization being assessed.

DISCUSS any additional staff that may be interviewed for different types of assessments.

ASK participants: In addition to documents and staff, what other resources might you be able to draw from?Possible answers:Site profileEntrance meeting Opening sessionFacility tour

ASK if there any questions before advancing to the next slide.

10ActivityClASS Clinical Review Scenarios

Gather relevant and accurate informatio