|At the Rivas hospital in the ER|
|One of the homes in the pilot micro-health insurance program|
|Cooking over a wood fire in proximity or |
within the home is very common in this community
Quality Improvement Project
Having worked at the community health post for the last few weeks, we have noticed a few aspects of the clinic that desperately need some improvement. The most glaring problem is the absolute MOUNTAIN of unorganized charts that piles a large bookshelf. The health post where we work is the largest in the area-with over 3,000 patients. And with over 600 new children born per year-the volume of patients is always growing.
Documentation of health records in Nicaragua is an absolute mess. When someone is born, the government issues that person one health card with a number on it. If they lose the card, it's gone forever. So when someone enters the clinic for a visit-it's really a toss up of if they still have their health card or not. Because the charts are organized by this issued number-it is impossible to find someone's chart without the number. The doctor then sees the patient without a past medical history and simply writes about the encounter on a piece of paper. All around the health post, piles of these loose papers sit without knowing which chart they belong to. In talking to Domingo, the current physician at the health post, he says that it is one of his greatest challenges. He sees patients who present with new complaints but do not know why they were hospitalized a month ago. He is continually making decisions without an adequate view of the patient. Then without this documentation, it is very difficult for him to follow up on a patient.
Our goal for the next few weeks is to create a system that the nurses are able to easily use to find patients. We have made a notecard look-up system where the patient can be looked up alphabetically by first name (everyone has a few last names and prefers to go by a different one). The notecard has name, issued number, and birthdate on it. Then we bought new folders for all of the charts (the old ones were falling apart) and organized them by a brightly labeled patient's number. This way, if a patient comes in and does not know their number (most patients), they can be looked up by first name, then using their number, their file can be found Hopefully this will then allow Domingo to have a full picture of the patient and also practice better follow-up.
|Jenny and one of our prenatal patients giving a talk|
|Checking blood pressure at prenatal visit|
|Las Salinas, one of our communities|