Step by Step of QAP 3

DATA COLLECTIONDATA COLLECTION

Courtesy From: Dato Dr. Abd Jamil AbdullahPakar Bedah PerundingHKT

Dr Suhazeli bin AbdullahDr Suhazeli bin AbdullahFamily Medicine SpecialistFamily Medicine Specialist

KK PermaisuriKK Permaisuri

Dr Suhazeli bin AbdullahDr Suhazeli bin AbdullahFamily Medicine SpecialistFamily Medicine Specialist

KK PermaisuriKK Permaisuri

9 - 11 April 2007 QA PKD Setiu 2

Problem Prioritisation

Quality Quality Assurance Assurance

CycleCycle

Problem Analysis

Quality Assurance

Study

Identification of Identification of Remedial Remedial ActionsActions

Implementation of Implementation of Remedial ActionsRemedial Actions

Re-evaluation of the Problem

Problem Identification


Plan for Data Collection

• Why plan?

• Clear overview of what tasks to be carried out

• Who should perform task• Duration of tasks

• Minimise errors & delays due to lack of planning

• Organise human & material resources efficiently



• How?

• Work Schedule

• List task• Who is involved• Time needed for different parts of study• Identify most appropriate time to begin study

• Gantt Chart

• Schedule different activities carried out


Gantt Chart

PerkaraApr 06

Mei06

Jun 06

Jul 06

Ogs 06

Sep 06

Okt 06

Nov 06

Dis 06

Penyediaan proposal dan material kajian

Taklimat & Latihan

Keluarkan surat arahan

Pengumpulan data

Analisa data

Penambahbaikan

Penilaian Semula

Laporan

Persembahan


Stages in Data Collection Process

• Stage 1• Permission to proceed

• Stage 2• Data Collection

• Stage 3• Data Handling


Stage 2: Data collection

Hence• Must know

i) WHAT data to collect

ii) WHERE to get the data


WHAT data to collect

Masa Menunggu

WHERE to collect data: A&E HS

Bil Masa pendaftaran

Masa jumpa doktor

Masa Menunggu

1. 8:00am 9:00am 1 jam

2. 8:45am 10:00am 1 jam 15 min

3. 10:00am 12:30pm 2 jam 30 min

Masa Menunggu di A&E


KAJIAN KEPUASAN PELANGGAN

WHATWHAT data to collectdata to collect

1055035MASA MENUNGGU

PENDAFTARAN

MASA MENUNGGU DOKTOR

53065

54321

54321

Sangat BaikBaikSerdahanaKurang memuaskan

Tidak memuaskan


WHAT data to collectWHAT data to collect

• Jumlah pesakit DM yang drop out

• Jumlah pesakit DM

No show patient for ENT opNo show patient for ENT op

Jumlah pesakit ENT yang no show

Jumlah pesakit yang diberi appt.

High follow-up drop-out rate of diabetic High follow-up drop-out rate of diabetic patient’s in KKKBpatient’s in KKKB


Masalah Yang Mungkin - Masalah Yang Mungkin - Severe NNJSevere NNJ

INCIDENCE OF SEVERE NNJINCIDENCE OF SEVERE NNJ

POOR IDENTIFICATION POOR IDENTIFICATION OF RISK OF RISK FACTORSFACTORS

POOR COMMUNITY POOR COMMUNITY COMPLIANCECOMPLIANCE

POOR DETECTIONPOOR DETECTIONOF NNJOF NNJ

Late referral NNJcases to MO at

HC/Hosp

Preference fortraditional Rx

Inadequateknowledge of

parents

Inadequate adviceto parents

Poor knowledgeamong staff

No / delayed /inadequate PNC

Poor / inadequatesupervision

Delayed/ untracedG6PD result

No NB checklist /guideline

No G6PDscreening

POOR MONITORING &POOR MONITORING &Mx OF NNJ @ HOMEMx OF NNJ @ HOME

Poor quality of PNC

Inadequatepoor recording

Late/no notificationof hosp delivery to

health

Badexperience


Stage 2: Data collection…

• Systematic collection of information

• Must know

iii) HOW to obtain data

iv) WHEN to collect data


Overlapping Prescription of Cardiac DrugsOverlapping Prescription of Cardiac Drugs

HOW to collect data

Review Outpatient Cards of Cardiac Patients

WHEN to collect data

1 Jan.1997 - 31 Jan.1997


HOW to collect data Review Maternity Notes

WHAT Newborn with A/S < 7 @ 1 min

WHENWHEN to collect data to collect data 01.11.2000 - 31.01.200101.11.2000 - 31.01.2001

WHEREWHERE PNWPNW

Total =Total = 108 cases108 cases

LOW APGAR SCORELOW APGAR SCORE


DATA: What Where How When

IMPROVING the MX OF DM TYPE II

Good Patient

Compliance

Healthy Lifestyl

e

Motivated /Knowledgeble

Staff

Adequateno. of staff

Pt. & Relative

Education

Dietician refferal

Good Family Suppor

t

Adequate dosage of

drugs

Follow CPG

Regular CME

Proper Mx of DM in

Ward

Positive Attitude



• Logistics :

Who will collect what- availability of staff / assistants- training needs, supervision

When- availability of staff- public holidays / vacation periods



• Logistics :How long

- consider time needed to locate study unit (persons, groups, records)

==> Gantt chart – Planning & Implementation Schedule


Patient ORIENTATION on

admission to the ward

Bil Kajian Tempoh Sampel Saiz

1. Prospektif dengan menggunakan Borang soal selidik

1.9.98hingga7.9.98

( 1 minggu )

Secara rawak Wad 1 25 pesakitWad 2 25 waris / penjaga Wad 3 25 pesakitWad 4 25 pesakitKecuali pesakit tenat

100


Data collection techniques(Primary or secondary data)

• Using available informationreview of recorded sources : literature, statistics, medical records

• ObservationHand washing technique, POP application, Wound dressing


Data collection techniques …

• Interviewing Face to face : Individual / Group

Facts on knowledge, attitude & behavior

Conducted in 2 ways - Fixed / Flexible


FLEXIBLE FIXED

1. Using open-ended questions with varied answers

1. Using prepared questionnaires with fixed answers

2. Sequence of questions changeable

2. Follow order of questions

3. Difficult to analyse / interpret

3. Easier

4. Suits small exploratory studies

4. Practical for larger samples

Interviewing…



• Administering written questionnaires

Mail

Hand-delivered

Group respondents in one place



Data Collection Tools

TECHNIQUES

TOOLS

Using Information Available

Checklist, Data-compilation forms

Observing Eyes & other senses, pen & paper, watch, scales, microscope, checklist, etc

Interviewing Interview schedule, checklist, questionnaire, tape recorder

Administering written questionnaire

Questionnaire



Variable Source of data

Method of Collection

Sample Unit SampleSize

Wrong appt given by nurse

Appt. book prospective analysis

All Unsatisfactory pap smear July 2003

100

Pt. did not follow appointment

Appt. book & pap smear form

prospective analysis

All Unsatisfactory pap smear July 2003

100

Knowledge on preparation staff

Self administered questionnaire

Cross sectional

All nurses 24 doctors 6 nurses

Knowledge on preparation patient

Self administeredquestionnaire

prospective All patients doing pap smear

50



Variable Source of data

Method of Collection

Sample Unit SampleSize

Technique of taking p / s

Observation check list

Performance appraisal

All doctors 50

Method of fixation

1.Pap smear form

2. Observation check list

1.Prospective

2. Performance appraisal

1. All Unsatisfactory pap smear July 2003

2. All nurses

50

Broken slide Pap smears form

Prospective All Unsatisfactory pap smear July 2003

100


KRITERIA PEMERHATIAN MARKAH

PENGAMBILAN SAMPEL ( Doktor )

Staf yang mengambil spesimen

Pakar MO HO

1. Tidak menggunakan “lubricant” Ya Tidak

2. Tanpa kecederaan Ya Tidak

3. Cara pengambilan dari servik yang betul Ya Tidak

4. Ada discaj Ya Tidak

Sekiranya markah 3 atau lebih, doktor berkenaan dianggap mahir

CHECKLIST


KRITERIA PEMERHATIAN MARKAH

PENGAWETAN SLAID ( Jururawat )1. Slaid direndam segera dalam alcohol

Ya Tidak

(dalam tempoh 1 minit drp. Sapuan pertama)

2. Slaid direndam sekurang-kurangnya 30 minit

Ya Tidak

Markah mestilah 100%

CHECKLIST

How much How much Data Data

To Collect ?To Collect ?

SAMPLINSAMPLINGG

How much How much Data Data

To Collect ?To Collect ?

SAMPLINSAMPLINGG


Sampling MethodSampling Method

Dependent on whether

sampling frame

is available


Sample Frame ?Sample Frame ?

Defining the characteristics of the study population that we want

e.g.diabetic patients with MOPD follow-up;

all discharged cases in postnatal ward


Methods of SamplingMethods of Sampling

Chances of being sampled unknown

a. Convenience sampling

b.Purposive sampling


a. Convenience samplingStudy units -available at time of data collection

e.g. All ENT patients listed for operation



b.Purposive samplingTarget a certain group

e.g. Medical BHTs



Chances of being sampled is known

a. Simple random sampling

b.Systematic sampling



a. Simple Random SamplingSimplest form

How: i) Make a numbered list of all

study unit in population from which to draw sample



ii) Decide on sample size

iii) Select required number of sampling units using a “lottery method” or a table of random numbers



b. Systematic Sampling

Sample unit chosen at regular intervals from sampling frame

Note: risk of bias



b. Systematic Sampling

How: i) study population

1,200 students of a schoolii) sample size

selected 100iii) sampling fraction

= ii / i = 100 / 1200 = 1 / 12



• Therefore Sampling Interval= 12

• Hence randomly choose thenumber of the first student to be included in the sample by blindly picking 1 of 12 pieces of paper numbered 1 to 12.



• If number 6 is picked, then every twelfth student will be included in the sample, starting with student number 6, until 100 students are selected

• The number selected will be 6,18, 30, 42, 54, ....



Appropriate sample size ?

• Minimum = 30

• Preferably = 50 - 100


Appropriate sample size ?Appropriate sample size ?

Bigger sample size NOT EQUAL Tobetter study

Better to increase accuracy of data collection

& get representative sample


ANYANY

Bengkel 4Bengkel 4

9 - 11 April 2007

QA PKD Setiu 44

Bengkel 4

QA study: Methodology1 Objectives: General & Specific2 Type of study3 Terms’ ( key words ) definition 4 Inclusion & Exclusion criteria5 Proposed Indicator and Standard6 Plan for data collection ( + proposed formats )7 Plan for data analysis ( + proposed dummy

tables )8 Gantt’s chart9 Refeences


Examples of QAP Outline

TAJUK2. Group3. Problem Identification/ Opportunity for Improvement 4. Prioritization & chosen/refined topic5. Situational analysis / Literature review 6. Opportunity statement7. Quality factor analysis / cause-effect analysis8. Process of care 9. Model of Good Care10. QA study: Methodology

10.1 Objectives: General & Specific10.2 Type of study10.3 Terms’ ( key words ) definition 10.4 Inclusion & Exclusion criteria10.5 Proposed Indicator and Standard10.6 Plan for data collection ( + proposed formats )10.7 Plan for data analysis ( + proposed dummy tables )10.8 Gantt’s chart10.9 References

04/11/23 QA PKD Setiu 46

Thank Thank YouYou

Step by Step of QAP 3

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