Audit project in The GambiaAudit project in The Gambia

Myriam BonduelleMyriam Bonduelle

Swansea Gambia LinkSwansea Gambia Link

The Swansea-Gambia The Swansea-Gambia Link aims to:Link aims to:• Form working partnerships between staff and Form working partnerships between staff and

students in Swansea and The Gambia to improve students in Swansea and The Gambia to improve health care outcomes  health care outcomes 

• Establish a broad partnership in health - including Establish a broad partnership in health - including clinical care, health service delivery, teaching and clinical care, health service delivery, teaching and research  research 

• Emphasise capacity development of staff and Emphasise capacity development of staff and students involved in the Link by including students involved in the Link by including education and training as part of activities education and training as part of activities wherever possible wherever possible

• Identify key areas of common interest that can be Identify key areas of common interest that can be developed as stand-alone projects developed as stand-alone projects

• Focus on facilitating improved health care delivery Focus on facilitating improved health care delivery (i.e. use teaching and training as part of broader (i.e. use teaching and training as part of broader projects to improve service delivery) projects to improve service delivery)

Visit to The Gambia Visit to The Gambia September 2007September 2007• Royal Victoria Hospital, Royal Victoria Hospital,

BanjulBanjul

• Medical School BanjulMedical School Banjul

• Party of 8 people from Party of 8 people from Swansea went out to Swansea went out to establish contactsestablish contacts

• Met up with Met up with representatives from representatives from most departmentsmost departments

Visit to The Gambia Visit to The Gambia September 2007September 2007Achievements:Achievements:

• Projects for collaboration identified:Projects for collaboration identified:– Audit supportAudit support– Support for pathology labSupport for pathology lab– Technical supportTechnical support– Student exchangesStudent exchanges

• Stimulated local discussion about Stimulated local discussion about future of first batch of junior doctorsfuture of first batch of junior doctors

Audit projectAudit project

Swansea ParticipantsSwansea Participants::• Dr Myriam Bonduelle, Consultant O&G, ABMU TrustDr Myriam Bonduelle, Consultant O&G, ABMU Trust• Dr Sharon Evans Consultant Radiologist, ABMU Dr Sharon Evans Consultant Radiologist, ABMU

TrustTrust• Ms Sharon Morgan, Clinical Audit and Effectiveness Ms Sharon Morgan, Clinical Audit and Effectiveness

Manager, ABMU TrustManager, ABMU Trust• Jess Griffiths, Learning technologist, Swansea Jess Griffiths, Learning technologist, Swansea

Medical SchoolMedical School• Dr Stephen Allen, Reader in Paediatrics, Swansea Dr Stephen Allen, Reader in Paediatrics, Swansea

Medical School and Honorary Consultant, ABMU Medical School and Honorary Consultant, ABMU TrustTrust

Purpose of the projectPurpose of the project

• The overall aim of this project was to The overall aim of this project was to combine audit capacity development combine audit capacity development of a key group of health care of a key group of health care professionals with the establishment professionals with the establishment of a means for local staff to evaluate of a means for local staff to evaluate and improve health care delivery in and improve health care delivery in The Gambia. The Gambia.

Phase 1Phase 1

• Adaptation of Swansea training Adaptation of Swansea training materials for use in The Gambiamaterials for use in The Gambia

• training in the principles of Clinical training in the principles of Clinical Audit to the Junior Doctors and Audit to the Junior Doctors and selected nurses and midwives at The selected nurses and midwives at The Royal Victoria Teaching Hospital in Royal Victoria Teaching Hospital in Banjul, The Gambia.Banjul, The Gambia.

Phase 1Phase 1

• Identification of local audit champions among Identification of local audit champions among the Senior Staff of RVTH and establishment of the Senior Staff of RVTH and establishment of local audit Committeelocal audit Committee

• support the identification and development of support the identification and development of audit projects by all the participants during audit projects by all the participants during the initial training, with encouragement of the initial training, with encouragement of multidisciplinary groupsmultidisciplinary groups

• continuous support through Email and continuous support through Email and internet by the Swansea team for the internet by the Swansea team for the duration of the projects, and analysis of data.duration of the projects, and analysis of data.

Phase 1Phase 1

• After completion of projects After completion of projects presentation of projects to all staff in presentation of projects to all staff in RVTH, as well as to the Clinical RVTH, as well as to the Clinical Governance teamGovernance team

• presentation of prize to best project.presentation of prize to best project.

Phase 2:Phase 2:

• Assistance with possible publication Assistance with possible publication of projects.of projects.

• Continuing support through the local Continuing support through the local Clinical Governance Group for future Clinical Governance Group for future auditsaudits

Achievements of phase 1 Achievements of phase 1

• grant was received from the Welsh grant was received from the Welsh Assembly Government Assembly Government

• Teaching materials developed, books Teaching materials developed, books on audit purchasedon audit purchased

• July 2008: 31 participants (25 junior July 2008: 31 participants (25 junior doctors, 4 Midwives, 2 general nurses). doctors, 4 Midwives, 2 general nurses).

• workshop also attended by 3 senior workshop also attended by 3 senior members of the Hospitalmembers of the Hospital

Six multidisciplinary groups formed, six Six multidisciplinary groups formed, six projects identified: projects identified:

1.1. Management of severe pre-eclampsia Management of severe pre-eclampsia and eclampsiaand eclampsia

2.2. Management of molar pregnancyManagement of molar pregnancy3.3. Staging of breast cancerStaging of breast cancer4.4. Postoperative wound carePostoperative wound care5.5. Use of the triage form in A&EUse of the triage form in A&E6.6. Management of advanced cervical cancerManagement of advanced cervical cancer

AchievementsAchievements

• Proformas designed for the projects, Proformas designed for the projects, with identification of the standards with identification of the standards which were to be auditedwhich were to be audited

• Team leaders identified Team leaders identified

• Senior staff members identified to Senior staff members identified to provide supportprovide support

• CMD confirmed support for the CMD confirmed support for the conceptconcept

Donation of Donation of books to books to LibraryLibrary

Workshop discussionsWorkshop discussions

What happened next?What happened next?

• Swansea team Emailed all the groups on Swansea team Emailed all the groups on return with formalised audit pro-formasreturn with formalised audit pro-formas

• First group of junior doctors who were First group of junior doctors who were generally team leaders all sent to Taiwan for generally team leaders all sent to Taiwan for further trainingfurther training

• Practically no further contact with any of the Practically no further contact with any of the team members despite various attempt from team members despite various attempt from usus

• No replies from identified senior Hospital No replies from identified senior Hospital DoctorsDoctors

Rescue plan:Rescue plan:

• Swansea students to go out during Swansea students to go out during the summer holidays to attempt to the summer holidays to attempt to complete at least one of the projectscomplete at least one of the projects

Pitfalls and lessons learnedPitfalls and lessons learned

• Need for food during workshops! – Need for food during workshops! – and possibly per diemsand possibly per diems

• Even though in our eyes the project Even though in our eyes the project was not ambitious the reality has was not ambitious the reality has proven otherwiseproven otherwise

• Working life is extremely busy for Working life is extremely busy for local doctors – small projects would local doctors – small projects would be bestbe best