Angkor Hospital for Children

Siem Reap, Cambodia

TREATMENT EDUCATION PREVENTION

SATELLITE CLINIC August 2013

Abbreviations

• AFH- Action for Health

• AHC- Angkor Hospital for Children

• APLS- Advanced pediatric life support

• CB- Capacity Building Project

• CME- Continuing Medical Education

• CP- Cerebral Palsy

• CQI- Continuous quality improvement

• ETAT- Emergency triage assessment and

treatment (WHO guidelines)

• ETT- Endotracheal tube

• GE- Gastroenteritis diarrhea

• HC- Health Center

• HEF- Health Equity Fund

• IC- Infection Control

• KBH- Kanta Bopha hospital: Siem Reap

• MOH- Ministry of Health

• NG- Nasogastric feeding

• OD- Operational District

• PP- Phnom Penh (Capital City of

Cambodia)

• PHD- Provincial Health Department

• Pro-TWGH- Provincial technical working

group for health

• SRH- Sotnikum Referral Hospital

• SW- Social Work

• UTI- Urinary tract infection

• VHV- Village health volunteer

Contents

• Monthly highlights

• Outpatients

• Health center referral

• Inpatients

• Inpatient diagnosis

• Emergency care

• Emergency room diagnosis

• Referral and transfer to AHC

• Neonatal care

• Education

• Transfer audit presentation

• APLS teaching and training in AHC

• SRH nurse training program

• Health center training

• Bangkok short course neonatal training

• Mot khla outreach on the Tonle sap lake

• Health education in Mot khla

• Community coordinator

• Conclusion

• Thank you

Monthly highlights • The highlight of August was the outreach activity on the lake for health education and health

promotion with a great team

• In the clinic Dengue fever is still present but the number of cases is slowly declining from peak

• Newborns and neonates were by far the majority of patients in the emergency room (30%) and the number of deliveries in SRH increased

• Education included a 2-day workshop in AHC on research ethics attended by some of our key nurses involved in a research study in AHC

• The results of a transfer audit were presented which will be key to making improvements in our processes

• The APLS course included 2 nurses from Satellite as participants and Dr Samol and Sokry from Satellite as instructors for the 3 day course held in AHC

• SRH and HC training continued with ever greater successes and positive feedback

Outpatients

Month HEF Other %HEF HC refer letter (ALL)

%HC referral Total

Jan 99 1150 8% 120 10% 1249

Feb 87 1029 8% 102 9% 1116

March 125 1243 9% 118 9% 1368

April 144 1223 10% 103 7% 1367

May 193 1094 15% 132 10% 1287

June 233 1338 15% 203 13% 1571

July 268 1399 16% 189 11% 1667

August 245 1184 17% 160 11% 1429

Sotnikum district HC referral

0

2

4

6

8

10

12

14

16

18

20

Chikreng district HC referral

0

2

4

6

8

10

12

14

16

18

20

Inpatients

Month HEF Other %HEF HC letter

Total

Jan 42 86 33% 6 128

Feb 43 77 39% 8 120

March 54 80 40% 12 134

April 52 65 44% 11 117

May 54 69 44% 7 123

June 51 98 34% 13 149

July 53 106 33% 12 159

August 64 76 45% 15 140

Inpatient diagnosis

Abcess, 3, 2%

Bronchiolitis, 5, 4%

AGN, 5, 4%

Dengue , 21, 15%

Dysentery, 5, 4%

Gastroenteritis, 12, 9%

Malnutrition, 3, 2%

Meningitis, 8, 6%

Neonatal infection, 13, 9%

Pneumonia, 8, 6%

Drowning, 2, 1%

Typhoid, 9, 6%

Septicemia, 14, 10%

Skin Infection, 7,

5%

Posioning , 5, 4% Other , 18, 13%

Febrile convulsion, 2, 1%

Emergency care

Month ER Patients ER transfer % transfer No. intubated

Total no. referred pts.

Jan 47 22 46% 6 42

Feb 47 12 26% 1 50

March 43 11 25% 1 40

April 52 14 27% 7 42

May 30 5 16% 2 30

June 57 11 19% 5 42

July 51 11 22% 2 44

August 42 15 36% 3 50

Emergency diagnosis

Seizure, 3, 7%

Meningitis, 4, 9%

Dysentery/GE, 3, 7%

Neonate, 12, 29% Pneumonia, 2, 5%

Burn, 2, 5%

Poisoning, 3, 7%

Trauma, 2, 5%

Other, 2, 5%

Septic shock, 3, 7%

Drowning, 3, 7%

malnutrition, 3, 7%

Referral and transfer to AHC

0

5

10

15

20

25

30

35

40

We transferred a total of 55 patients from OPD, IPD and ER 3 were transferred intubated

Neonatal Care

• We had a total of 14 newborns within their first week of life

• 12 of these from health centers

• 50% were premature

• The number of deliveries increased in SRH nearly 60% this month compared to 2012 (from 12 to 29)

• New innovations developed and implemented in Satellite by our motivated and creative nursing staff include:

• the baby hat with a chin strap for use with oxygen therapy (CPAP)

• a baby G-string which allows for maximum skin exposure to phototherapy compared to a regular diaper for small babies

• Calming music to reduce anxiety

Education • Lunch talks included neonatal assessment,

transfer audit, and a homecare presentation

• Impressively Dr Ladin a new junior doctor gave a CME lecture on a case of melioidosis. Well done!

• Nurses involved in the AHC IBIS study joined a 2-day research ethics workshop in AHC

• Continuing educational activities include:

• Nursing students in clinical placement

• English classes for intermediate and beginners

• Teaching ward rounds for both nurses and docs

• Daily education to patients and their caretakers is given by nurses on a variety of topics included nutrition, hygiene, malaria prevention etc.

Transfer audit presentation

• Dr Claudia presented the results of the Satellite clinic transfer audit looking at all the transfers in 2012 from Satellite to AHC

• Preliminary results show that most of transfers are well timed and occur within one day of admission in Satellite

• The team are now going to work on a plan of action to improve and we will re-audit with prospective data and evaluate again at the end of the year

• Acknowledgements to the following people who all spent a considerable amount of time and effort collecting data, analyzing and reporting the findings

Thank you • Claudia Turner • Sreymom Pol • Dith Vankheng • Erin Mc Gonagle • Nicolas Woolnaugh • Rebecca Glassford • MORU

APLS teaching and training in AHC

• The Advanced Pediatric Life Support 3 day course was held in AHC and nurse Sovimean (photo below) and Sriemean were participants (photo top in pink)

• Dr Samol is an experienced instructor and Kol Sokry team leader nurse joined the team as an instructor for the first time (photo top)

• Sokry learnt the importance of making lectures interactive not didactic, listening carefully to questions and motivating the participant

• He also learnt about being part of a team of instructors and the different roles and responsibilities that entails

• Congratulations to all on a successful course

SRH nurse training program • Coaching and training for SRH nurses continues

with good feedback and results

• This month the Satellite education group joined to teach them 3 times and focused on teaching how to take an accurate respiratory rate and how to record oxygen saturations

• Teaching is given initially on respiratory anatomy and physiology, the importance of the vital sign and on techniques to use with patients to ensure accuracy and finally the correct recording and documentation

• In addition the SRH nurses also learnt fluid and medication calculations

• These are some of the essential basics that will ensure quality care improvements in SRH

Health center training

• Health center training was given to Kien Songke and Song Vuey health centers in collaboration with CBHEP and with good feedback

• Dengue refresher course was presented as it was most topical and requested from the HC staff

• In addition signs of critical illness and severity that need transfer to Satellite were also reviewed

• Health center training also gives our team an opportunity to encourage and motivate HC staff and strengthen the referral process and relationship with Satellite

Neonatal course in Bangkok

• Nurse Vichet has left with 3 nurses from AHC to join the 4 month Neonatal program in Bangkok (top left and bottom right)

• They are already busy with the theory part of the course and are being introduced to many different teaching and learning styles for example seminar presentation

• In addition they are learning with an international group of students and are sharing experiences as well as gaining cultural exchange

• They have covered health assessment, learnt about health systems and the role and development of the nurse

Mot Khla outreach on the lake • A multidisciplinary team of 13 from Satellite

including the Jefferson family ventured out to the lake village of Mot Khla to do some health education and health promotion activities

• Ably led by Community Coordinator Sambath the team provided teaching on nutrition, appropriate use of medications, oral hygiene, and general hygiene and hand washing

• Soap, toothbrushes and toothpaste were distributed and 3 clean water filters were presented to the local primary school one for each classroom

• In addition the HEF staff were able to explain the referral process and reimbursement for poor patients

Health education in Mot Khla • Alexis and Kendre Jefferson are giving a

demonstration on effective oral hygiene and brushing technique which was translated by Samnang

• Oral hygiene is one of the most challenging areas of health promotion. Donations of toothbrushes, toothpaste and soap were given to all

• Our pharmacist Chiva gave a lecture on appropriate and safe use of medications, explaining the dangers of taking medicine from a friend or buying unlabeled medication from a village seller, and the dangers of giving adult medication to a child

• These are all issues we see in Satellite and the outreach day was a great opportunity to promote good practice and educate the community

Community coordinator

• Aside from planning and leading the team to Mot Khla, Sambath has also been engaged in a myriad of other activities including:

• 1st Step Cambodia Social work training

• OD and daily SRH meetings

• Social work cases and follow up patients

• Sotnikum Community Forum lead by the development council of Sotnikum and included 10 NGO’s across sectors (photo below)

• VHV meetings at the Russie Lok, Samroung and Pongro Leu health centers

Conclusion • August shows a variety of activities which

capture the spirit of Satellite Clinic

• Quality multidisciplinary care including physiotherapy, social work etc.

• Innovation (Neonatal care)

• Continuous striving to improve (transfer audit)

• Reaching out to the community (Mot Khla lake trip)

• Health education and promotion

• Teaching and coaching (APLS and SRH nurses)

• Education (student nurses and health center teaching)

In essence the Satellite Clinic activities and influence are expansive and far-reaching; made possible by a fantastic team of dedicated Khmer staff

Thank you

With sincere thanks to The

Planet Wheeler

Foundation and

The Cassils-Wettstein Asia

Fund for their support

Thanks to the PHD, OD , AHC staff and volunteers who generously give their time, knowledge and expertise here on the ground

And of course thanks to Satellite and SRH staff for their hard work to make all of these achievements possible