Hello All,
I hope everyone is doing well in Hamilton. Today the team went to Mbarara Hospital to meet with Dr. Ttendo, the Mbarara IOP coordinator, along with the other Mbarara team members to start our day. I was very fortunate to have the opportunity to spend yesterday and today with the day with Sister Agirie, the Senior Nursing Officer for the hospital. I met Sister Agirie in July 2009, so this meeting was our second opportunity to come together to represent nursing, while discussing and reviewing our goals and our role as a team to reduce maternal mortality.
Our main IOP goal is to focus on reducing maternal mortality. Dr. Saramin Galinski donated misoprostol to Mbarara hospital, because at times the hospital does not have medication to help women who are experiencing postpartum hemorrhage (PPH).Misoprostol is an inexpensive medication that can be stored at room temperature, and is an effective medication in controlling postpartum hemorrhage. Agirie and I reviewed guidelines for care of the unstable postpartum patient. Julie Pace, our SJHH nurse educator, sent with me, our documentation form for PPH and copies of guidelines,that help support nurses to provide care for patients with PPH.
On my last visit to Mbarara, Sister Agirie and Senior Administration express some concern about the lack of Standards of Behaviour between colleagues. I review SJHH Standards of Behaviours with Agirie, and also gave a copy of our booklets to lead physicians, so that they can have a template, so that they may create their own, and possibly implement their own version of standards of behaviour, within the maternity units (triage, labour and delivery and postpartum)
I had the opportunity to work with the head nurse in labour and delivery to discuss the flow of their patients as they come in to the hospital. Mbarara hospital delivers approximately 7000 babies each year. They have 3 midwives working on day shift, 2-3 midwives on evening shift and 2 midwives working on night shift. They have a high volume of assessment patients along with admitting patients for delivery. There were medical learners, residents and nursing students present on the unit during the day shift, and all of their help was needed to care for the volume of patients that required care. Understanding patient flow within this department is another goal that Agirie and I identified, and with the assistance of head nurse Judith, we are creating a patient flow map to try to understand how the patients flow through the department. At times patients arrive for an assessment or for delivery and because of the high volume of patients around, the staff do not even know a new patient has arrived for care. Sister Judith made a wonderful suggestion to simply move the registration desk closer to the entrance, so that all patients can be logged in upon arrival. This simple solution has many barriers, yet with the process flow map, we will make this recommendation, which will hopefully get buy-in from the entire team. This can be a small test of change as we move through the process flow map, which may help to control their work environment and the patient flow in a more effective manner. This simple change may also support more timely access to care for high risk patients that return to the hospital with PPH, or sepsis, therefore helping to support our goal of reducing maternal mortality.
After spending two days with Agirie and her nursing staff we were able to review the PDSA change mode, which will be a great framework that can be used to introduce new small test of change to this department. Jessica provided an in-depth overview of the PDSA cycle, which was embraced by the entire nursing and physician teams at Mbarara.
Sister Agirie and her team have been very welcoming and they all have been very eager to develop and support positive changes within their department.
More to come...
Take care,
Marnie, Saramin and Jessica
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