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Browsing Protocol by Author "Freyner, Bridget"

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    Pilot Implementation of a multi-faceted COVID-19 response at the department of paediatrics, QECH
    (Kamuzu University of Health Sciences, 2020-09-16) Freyner, Bridget
    Type of Study This is a mixed-methods pilot implementation study Problem COVID-19 is the current major disease of concern globally. The guidance developed by the World Health Organisation (WHO) to help in the implementation of infection prevention and case management of COVID-19 must be locally relevant for it to be effective in Malawi. This study will apply the RE-AIM framework to assess key process and implementation outcomes of the QECH Paediatric COVID-19 response. The QECH Paediatric departmental response to COVID-19 has three elements (i) the implementation of WHO guidance on infection prevention, rationale use of PPE and case management of children with suspected COVID-19 disease (ii) ongoing monitoring and evaluation of in-patient case load, case fatality rate and quality of care and (iii) the development of strategies to minimise in-patient length of stay. Underpinning these three elements are ongoing communication strategies, logistics support and real-time data utilisation through audit-feedback. The aim of this study is to describe the implementation of this response and to pilot strategies for (i) real time data utilisation and (ii) reduction of in-patient length of stay to mitigate against both the direct and indirect effects of COVID-19. Specific Objectives I. To evaluate the implementation of COVID-19 specific guidance (infection prevention, environmental cleaning and the rationale use of PPE) and how it changes over the course of the epidemic. II. To evaluate the pilot implementation of a data dashboard and associated learning system on (i) compliance with COVID-19 guidance and (ii) in-patient quality of care. III. To describe the effect of the COVID-19 epidemic on the in-patient caseload, case fatality rate and in-patient quality of care compared to baseline. IV. To determine the optimal strategies for minimising in-patient length of stay in our department with the aim of reducing unnecessary patient exposure to COVID-19. IV.V. To generate pilot effectiveness data on the utility of a “learning system” to support the COVID- 19 response at the QECH paediatric department. Methods: All elements of the COVID-19 response (the intervention) will be described at baseline using the TiDieR checklist. The implementation of this response will be assessed using a modified RE-AIM framework, supplemented with qualitative enquiry based on the Consolidated Framework for Implementation Research. A key element of the intervention is real time data utilisation via implementation of a data dashboard. The dashboard will be updated weekly. The aim of the dashboard is to provide a “learning” system to inform ongoing COVID-19 specific activities and maintain in-patient quality of care through identification of key indicators requiring improvement on a weekly basis which will be entered into a PDSA cycle. The efficacy of the dashboard will be defined as a 20% improvement in the chosen indicator over the following month. A key safety element in the COVID response is minimising unnecessary length of stay (LOS) for in-patients. We will pilot two strategies to reduce inpatient LOS; (i) IV-PO switch antibiotic ward rounds and a (ii) care pathway for complex patients. These interventions will be developed through (i) audit of existing practices including 6 months of retrospective data review and (ii) participatory work-shops with clinicians and nurses in the department. Pilot efficacy of these interventions will be assessed by comparing length of stay and changes in antibiotic prescribing days in the department. The interventions will be refined through feedback from key users and developed for future formal process evaluation.