The International Hospital Kampala (IHK), a 100-bed private hospital in Uganda and part of the International Medical Group, has reported a significant drop in hospital-acquired infections (HAI) and improved monitoring of continuous quality improvement and adverse events since its second accreditation with the Council for Health Service Accreditation of Southern Africa (COHSASA).

This is according to hospital staff who have been working with the accreditation programme since 2014 and with the Council’s Patient Safety Information System (PatSIS) since May 2015.They have been collecting data to back up their claims.

IHK is the only COHSASA-accredited hospital in Uganda. IHK first entered the COHSASA programme in April 2014 and received its first full accreditation award in August 2015 with a score of 86 out of 100. The hospital re-entered into the programme soon afterwards and in November 2017, the COHSASA Board accredited IHK for three years when a score of 97 was achieved.

“COHSASA accreditation has been a very worthwhile exercise for IHK since it is one of the few specific medical accreditations and benchmarks that can be carried out by a hospital in Africa. Previously we had ISO certification which was non-specific. We are happy to have full COHSASA certification for the second-time around,” said Chairman of the International Medical Group, Dr Ian Clarke.

According to Head of Quality Assurance for IHK, Jackie Nabukeera, the hospital decided to enrol in the COHSASA programme because COHSASA standards are specific to a healthcare setting. “We wanted to know how different departments in a hospital were supposed to be operating to implement the relevant internationally-accepted standards,” said Nabukeera.

As a hospital, IHK had specific quality problems which included, but were not limited to: documentation, measuring hospital acquired infections, risk identification and mitigation and measuring quality improvement.

“It was important for us to respond to these issues so that continuity of care and appropriate interventions for the patients could be made,” said Nabukeera.

“In addition, the web-based CoQIS quality information programme generated data that could be collected and analysed to inform different quality improvement projects. However, as with any new programme, there were challenges: poor staff buy-in and lack of adequate knowledge to drive the hospital’s QI programme to mention but a few. This meant we had to make concerted efforts to communicate the importance of the quality improvement programme at staff meetings and training staff to equip them with the knowledge they needed to steer the QI programme. We also needed to collar the support from the executive and senior management team,” continued Nabukeera.

According to Unit Manager of the IHK ICU, Lilibet Byakika, the quality improvement and accreditation programme has positively impacted patient care and infection control.

“Infection control has been a great success because we have been pushing hand washing, where techniques have been mastered and practiced by staff and the patients’ attendants. Through hand washing audits we have been able to monitor compliance among the staff. This has reduced cross infection in our patients and there is a massive reduction in the rates of nosocomial infection,” said Byakika.

“Monitoring and reporting of critical events using COHSASA’s Patient Safety Information System – PatSIS – and morbidity and mortality audits have greatly improved our knowledge of critical care and made us better practitioners than before,” continued Byakika.

According to the IHK Obstetrics & Gynaecology Ward Manager, Eva Nambugu, the standards have helped the department carry out self-assessments to identify gaps and find possible ways of closing them. For example, protocols, guidelines, tools and checklists have been developed to correct the gaps and reduce mistakes.

“The programme has also improved our ability to obtain meaningful data collection and analysis which has set a basis for continuous improvement,” said Nambugu.

“We have been able to monitor performance competence by using the checklists we have put in place. Due to the care tools, guidelines and protocols we have developed we are able to assess the quality of care we render to our clients. When incidents occur, we investigate the root cause and then work to mitigate them,” continued Nambugu.

The COHSASA Patient Safety Information System (PatSIS) is also being used by the hospital to improve efficiencies.

“PatSIS has created transparency in the medical-surgical ward and challenges in the unit are being sorted out with ease. For example, because of reporting these near-misses and incidences, the administration has helped fix our nurse-call system and currently they are purchasing new equipment for the unit,” said Unit Manager of the IHK Medical-Surgical Ward, Peace Natimba.

“More so, near-misses and adverse incidences are being managed head-on since the unit members feel free to report them in the system. These have all aided the provision of quality care to our patients as well as increased their satisfaction with our service,” concluded Natimba.

COHSASA is the only internationally accredited quality improvement and accreditation body for healthcare facilities based in Africa. In the past 23 years, over 550 facilities throughout the continent have entered the COHSASA programme to improve the quality and safety of the healthcare services they provide to patients.

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