Pediatric сlinic of Odessa National Medical University: the quality of emergency medical care for children
Background. The purpose of the article is to discuss the issue of improving the quality of emergency care for children with the most common diseases. Materials and methods. The quality of medical care includes 6 characteristics: 1) effectiveness — evidencebased health care results in improved health outcomes; 2) relevancy: health care is delivered in a manner that maximizes resource use and avoids wasting and provided in a setting where skills and resources are appropriate to medical need; 3) accessibility: health care is provided timely, reasonable and affordable; 4) acceptability/patient-centered: health care provided takes into account the preferences and aspirations of individual service users; 5) equity: health care provided does not vary in quality because of personal characteristics or socioeconomic status; 6) safety: health care provided minimizes risks and harm to service users and providers. Results. The Intensive Care Unit (ICU) started working in the Pediatric Clinic of the Odessa National Medical University on February 1, 2017. The main task of ICU is the treatment of children with emergency conditions (who needs monitoring of breathing and cardiac activity, oxygen therapy, large-volume rehydration therapy, etc). The patients admit to the ICU according the results of triage. Triage is the process of rapidly screening of sick children soon after their addmission to hospital and in ICU, in order to identify those with emergency signs — obstruc-ted breathing or severe respiratory distress; central cyanosis; signs of shock; signs of severe dehydration; those with priority signs — very high temperature, severe pallor, respiratory distress etc. The local guidelines for the most common diseases in children have been developed in the Pediatric Clinic. These local guidelines are based on: 1) modern national guidelines; 2) WHO: Pocket book of hospital care for children: guidelines for the management of common childhood illnesses (2013); clinical guidelines of the United States, Great Britain, Canada, Australia; Ukrainian National Formulary; British National Formulary for Children. All medicines included in these local guidelines are presented in the WHO Model List of Essential Medicines (April 2015). In the Pediatric Clinic the medical care is patient-centred, responsive to and respectful of the patient’s values and choices to promote patient satisfaction and fulfillment of human rights. We use the patient-centred technologies: mothers and infants to remain together 24 hours a day; the preference is given to oral rehydration, rather than intravenous fluid administration; the minimization of pain for all manipulations, to refuse any intramuscular injections; to usage of screening test systems for the diagnosis of Beta-hemolytic streptococcus, rotavirus, influenza, bacteriuria; the humidification of air around the patient. The average period of staying in the ICU is 2 days. The culture of patient safety is a priority in the Pediatric Clinic. The culture of patient’s safety includes: the changing of the attitudes of medical staffs towards the safety of medical care; the identification of triggers and risks of medical care; the identification of all medi-cal errors/“no harm events”/“near miss events”; the implementation of safe technologies, simple algorithms; learning of medical staff. There were more than 40 lectures and practices for medical staff of the Pediatric Clinic, including the training courses CODE BLUE. Conclusions. The measures aimed at improving the quality of emergency medical care for children in the Pediatric Clinic of the Odessa National Medical University are: 1) the organization of ICU and equipping it with mo-dern equipment for diagnose and treatment of children; 2) the triage of patients according to the condition severity by the objective criteria; 3) the reducing of terms of hospitalization due to optimization of treatment in ICU; 4) standardization of medical care by developing local guidelines based on the principles of evidence-based medicine; 5) the increasing the acceptability of medical care through the implementation of patient-centred technologies; 6) the implementation of culture of patient safety; 7) the continual training of medical staff.
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Levels & Trends in Child Mortality. Report 2015 Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation. UNICEF, 2015. 33 p. Available from: http://www.who.int/maternal_child_adolescent/documents/levels_trends_child_mortality_2015/en/
Improving the Quality of Care for Reproductive, Maternal, Neonatal, Child and Adolescent Health in the WHO European Region. A Regional Framework to Support the Implementation of Health 2020. Available from: http://www.euro.who.int/__data/assets/pdf_file/0009/330957/RMNCAH-QI-Framework.pdf?ua=1
Health 2020. A European policy framework and strategy for the 21st century (2013). Available from: http://www.euro.who.int/en/publications/policy-documents/health-2020.-a-european-policy-framework-and-strategy-for-the-21st-century-2013
Zakon Ukrainy «Pro vnesennja zmіn do Osnov zakonodavstva Ukraїni pro ohoronu zdorov'ja shhodo udoskonalennja nadannja medichnoї dopomogi (Vіdomostі Verhovnoї Radi Ukraїni, 2012, N 14 [The order ‘About amendments to framework legislation of Ukraine about healthcare about improvement rendering medical care (Journal of Verkhovna Rada of Ukraine, 2012, N 14). 86 p. (In Ukrainian). Available from: http://zakon3.rada.gov.ua/laws/show/3611-17
Zakon Ukraїni "Pro ekstrenu medichnu dopomogu" (vіd 05.07.2012 N? 5081-VI) іz zmіnami,vnesenimi Zakonom N 333-VII vid 18.06.2013 [The Order of Ukraine ‘About urgent medical care’ dated 05.07.2012 N 5081-VI as amended by the Order N 333-VII dated 18.06.2013]. (In Ukrainian). Available from: http://zakon3.rada.gov.ua/laws/show/333-18/paran228#n228
WHO: Pocket book of hospital care for children: guidelines for the management of common childhood illnesses. 2nd ed. 2013. 412 р. Available from: http://www.who.int/maternal_child_adolescent/documents/child_hospital_care/en/
Nakaz MOZ Ukraїni vіd 28.09.2012 № 751 "Pro stvorennja ta vprovadzhennja mediko-tehnologіchnih dokumentіv zі standartizacії medichnoї dopomogi v sistemі Mіnіsterstva ohoroni zdorovja Ukraїni [The Order of MoH of Ukraine dated 28.09.2012 N 751 ‘About development and implementation medical technical specification on unification of medical care in health care system in Ukraine’. (In Ukrainian). Available from: http://www.moz.gov.ua/ua/portal/dn_20120928_751.html
WHO Model List of Essential Medicines. 2015. 55 р. Available from: http://www.who.int/medicines/publications/essentialmedicines/en/
Medical Error Is Third Leading Cause of Death in US. Medscape.
Hughes RG. Patient Safety and Quality. An Evidence-Based Handbook for Nurses. 2008. (AHRQ Publication N 08-0043). Available from: https://psnet.ahrq.gov/resources/resource/7178
The Paediatric Trigger Tool. User guide. 2014. 23 р. Available from: http://bmjopen.bmj.com/content/suppl/2014/07/03/bmjopen-2014-005066.DC1/bmjopen-2014-005066supp2.pdf
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