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Module 9 Part B

Using the Supervisory


Checklist
How do I monitor?

• The supervisory checklist gives you a


structure you can use …

• … but it should not limit what you look at

• There are further steps to take to interpret


the data and get a complete picture
The Supervisory Checklist
• Take a look at the
supervisory checklist
• Understand the scoring
system
• We’re going to look at three
important parts of the
checklist:
– Suspect and Sputum
Dispatch Register
– TB Facility Register
– Treatment Card
The Supervisory Checklist

• Scoring System
• 0 Not Done
• 1 Poor
• 2 Satisfactory
• 3 Good
The Supervisory Checklist

• Scoring System • Per Quarter


• 0 Not Done • Entry not completed
• 1 Poor • <75% complete
• 2 Satisfactory • >=75% complete
• 3 Good • >= 90% complete
The Suspect and Sputum
Dispatch Register

1. Regularly Used: All Registered TB cases found in SSD; additional


unconfirmed Suspects also in SSD; SSD used for registering f/up exams.
Good= On average, 90% of confirmed cases and f/ups logged in.
2. Columns complete: Good= On average, 90% of columns completed.
3. Suspects have 3 Sputums. Good= On average, 90% suspects have 3
specimens logged in.
4. Results Correctly Recorded. Good= On average, 90% of logged entries have
results for all specimens recorded as N or P with a grade 1+ 2+ etc.
Three sputum smears examined?

• Level of knowledge:
– Do the HCWs understand the need for three
sputum smears?
• Attitude / Perception
– Do they care? Are they interested in complete,
quality data?
• Seeking guidance
– Do they have questions?
Checklist: The TB Register
Is the Register Complete?

 Level of knowledge:
 Do the HCWs understand what each
column is for?
 Attitude / Perception
 Do they care? Are they interested in
complete, quality data?
 Seeking guidance
 Do they have questions?
Checklist: The TB Register

1. Confirmed ases registered (compared to Lab Reg and SSD)


Good= On average, 90% of confirmed cases registered.
2. Pt Information complete: Good= On average, 90% of columns completed.
3. Sputum results recorded. Good= On average, 90% suspects have correct
number of specimens AND results recorded
4. Compliance correctly recorded. Good= On average, 90% of doses to date
recorded and signed
Checklist: The TB Register

5. Treatment outcome recorded correctly: Cured or Completed based on


presence of bacteriology results. “DISCHARGED” IS not AN OUTCOME!
Good= On average, 90% of confirmed cases registered.
6. HIV results recorded: Good= On average, 90% of columns completed as
positive OR negative.
7. IPT History recorded. Good= On average, 90% of HIV+ cases have been
asked whether they ever received IPT & date started
8. ART status: Good= On average, 90% of HIV+ cases have been asked whether
they are on ART & date started.
All Sputum Results Recorded?

 Level of knowledge:
 Are the HCWs familiar with 1+, 2+ etc.?
 Attitude / Perception
 Do they know that microscopy is essential
for diagnosis?
 That follow-up is essential for patient
monitoring and documenting cure?
 Seeking guidance
 What do they need to understand to do their
job better?
The comments column:
Why is this important?
Task Scor Comment
e
1. All suspected Dropped from 95% in last supervision to
cases have three 1 20% in this supervision.
sputum investigation
2. Patient’s DOT Workers report that they do not
compliance is understand how to use the form and are
1 too busy to do it.
correctly recorded

 What does the score tell you?


 both activities are poorly done This is your chance to
be heard.
 What do the comments tell you?
 Something caused a sudden drop in indicator 1
 DOT workers need training
Checklist:
Patient Treatment Card
Communication with
DOT Workers
Some communication tips (2)
DO’s:

 Listen and be prepared to


learn
 Give the person space
and time to answer DONT’s:
 Be tactful and discrete  Don’t “lead the witness” –
 Talk to as many people as ie don’t try to get the
possible (at all levels) answer you want to hear
 Don’t overreact to a
negative verbal report. First
check against the data,
then form an opinion.
Planning the supervision
visit
Logistics

1. Make a list of all the facilities in your district


- Include the name and cell phone number of
the Matron and TB Focal Person
2. Group them by location/region
Facilities in the District capital where you work and
reside will be the busiest and the easiest to visit,
so
3. Plan your visits to outlying areas first
4. Schedule local facility and lab visits next
Scheduling supervisory visits

For example, split the district into sections and


visit different regions on alternate weeks

Date District Region Clinics to be visited


1st Monday Chobe Northern Chobe Kasane PH, Kachikau
Clinic,
Pandamatenga Clinic,
etc
2nd Monday Southern Chobe Satau, Kazungula,
Plateau, etc.
Supervisory Visits
 Confirm the dates with the TB Focal Person or Matron
before arriving
 Provide explicit expectations
• Are treatment cards organized and complete?
• Is register up-to-date?
• Have they made a list of things requiring your
follow-up? (e.g., transfers)
 Listen and note problems or issues they are
experiencing (e.g., test kit shortages)
 Offer to bring needed supplies
Checklists and Reminders

 Checklists and reminders are a good


visual aid
 Should be clear and concise, strategically
placed
 Well-designed and visually pleasing
Communication about
next steps / debriefing
Some communication tips (3)

DO’s:

given
 Report back on what

 Follow any lead you are
DONT’s:

 Don’t dismiss anyone’s
steps can / should be taken concerns
 Encourage internal  Don’t worry if you don’t
discussion and try to have an immediate answer.
“facilitate” a solution You might need to talk to
 Identify experienced lots of people.
people and draw from their  Don’t take anything at
experience face value. Check against
the data!
Exercise 9.1

 Working alone, review the sample


suspect register worksheet
 Answer questions 2-4 on your handout
 Faculty will assist
Exercise 9.2

 Using the handout, review the register


and make note of any possible
problems in recording and reporting
 Enter a score and your findings into the
supervision checklist
 Discussion
Exercise 9.3

 Based on your observations and analysis in


the previous exercise develop follow-up
checking questions for the following
indicators in the supervision checklist:
 Patient’s attendance is correctly recorded
 Patient’s information is complete
 All HIV Status results are correctly recorded
Exercise 9.4

 Working in groups, and using the patient


register, calculate the following indicators:
 AFB Diagnosis Rate
 Program Default Rate
 Sputum Conversion Rate
 Proportion of notified cases tested for HIV
 Enter your findings and interpretation into
the supervision checklist
Exercise 9.5

 Working in pairs, review the sample


treatment cards
 Calculate % of patients who received all
treatment under DOT
 Review quality of recording and reporting
 Enter a score into the supervision
checklist, along with comments
 Faculty will assist

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