Step by Step of QAP 3

DATA COLLECTION
Dr Suhazeli bin Abdullah Family Medicine Specialist KK Permaisuri

Courtesy From: Dato Dr. Abd Jamil Abdullah Pakar Bedah Perunding HKT
Problem Identification
Problem Prioritisation
Re-evaluation of the Problem
Quality Assurance Cycle
Problem Analysis
Implementation of Remedial Actions
Quality Assurance Study
Identification of Remedial Actions

9 - 11 April 2007 QA PKD Setiu 2
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
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QA PKD Setiu

How?
Work Schedule
List task Who is involved Time needed for different parts of study Identify most appropriate time to begin study
Gantt Chart
9 - 11 April 2007
Schedule different activities carried out

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Gantt Chart
Perkara Penyediaan proposal dan material kajian Taklimat & Latihan Keluarkan surat arahan Pengumpulan data Analisa data Penambahbaikan Penilaian Semula Laporan Persembahan 9 - 11 April 2007 QA PKD Setiu 5 Apr 06 Mei 06 Jun 06 Jul 06 Ogs 06 Sep 06 Okt 06 Nov 06 Dis 06
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) ii) WHAT data to collect WHERE to get the data
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QA PKD Setiu
Masa Menunggu di A&E

WHAT data to collect
Masa Menunggu
Bil Masa pendaftaran Masa jumpa doktor Masa Menunggu
1.
2. 3.
8:00am
8:45am 10:00am
9:00am
10:00am 12:30pm
1 jam
1 jam 15 min 2 jam 30 min
WHERE to collect data: A&E HS

KAJIAN KEPUASAN PELANGGAN

Tidak memuaskan Kurang memuaskan Serdahana Baik Sangat Baik
1
MASA MENUNGGU PENDAFTARAN
1
MASA MENUNGGU DOKTOR
2 35
3 50 65
4 5 30
5 10 5
9 - 11 April 2007
QA PKD Setiu

High follow-up drop-out rate of diabetic patients in KKKB Jumlah pesakit DM yang drop out Jumlah pesakit DM
No show patient for ENT op

Jumlah pesakit ENT yang no show Jumlah pesakit yang diberi appt.
Masalah Yang Mungkin - Severe NNJ

Delayed/ untraced G6PD result No / delayed / inadequate PNC No G6PD screening Poor / inadequate supervision Poor knowledge among staff
No NB checklist / guideline POOR IDENTIFICATION OF RISK FACTORS
POOR DETECTION OF NNJ

Poor quality of PNC
Inadequate knowledge of parents
INCIDENCE OF SEVERE NNJ

POOR MONITORING & Mx OF NNJ @ HOME
Preference for traditional Rx
POOR COMMUNITY COMPLIANCE
Inadequate poor recording Late referral NNJ cases to MO at HC/Hosp

11
Inadequate advice to parents

9 - 11 April 2007
Bad experience
Late/no notification of hosp delivery to QA PKD Setiu health

Systematic collection of information Must know
iii) HOW to obtain data

iv) WHEN to collect data
Overlapping Prescription of Cardiac Drugs
HOW to collect data

Review Outpatient Cards of Cardiac Patients
WHEN to collect data

1 Jan.1997 - 31 Jan.1997
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LOW APGAR SCORE

HOW to collect data
WHAT
Review Maternity Notes
Newborn with A/S < 7 @ 1 min

01.11.2000 - 31.01.2001
WHEN to collect data
WHERE
PNW
Total = 108 cases

DATA: What Where How When

Adequate no. of staff Regular CME Motivated / Knowledgeble Staff
Pt. & Relative Education
Follow CPG
Dietician refferal Adequate dosage of drugs
IMPROVING the MX OF DM TYPE II

Positive Attitude
Proper Mx of DM in Ward
QA PKD Setiu
Good Patient Compliance
Good Family Suppor t
9 - 11 April 2007
Healthy Lifestyl e
15

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 1. Kajian Prospektif dengan menggunakan Borang soal selidik Tempoh 1.9.98 hingga 7.9.98 ( 1 minggu ) Sampel Secara rawak Wad 1 25 pesakit Wad 2 25 waris / penjaga Wad 3 25 pesakit Wad 4 25 pesakit Kecuali pesakit tenat Saiz 100
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Data collection techniques (Primary or secondary data)

Using available information review of recorded sources : literature, statistics, medical records
Observation Hand 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

Interviewing
FLEXIBLE 1. Using open-ended questions with varied answers 2. Sequence of questions changeable 3. Difficult to analyse / interpret 4. Suits small exploratory studies
9 - 11 April 2007
FIXED 1. Using prepared questionnaires with fixed answers 2. Follow order of questions 3. Easier 4. Practical for larger samples
21
QA PKD Setiu

Administering written questionnaires
Mail
Hand-delivered
Group respondents in one place
Data Collection Tools

TECHNIQUES Using Information Available Observing TOOLS Checklist, Data-compilation forms 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 Sample Size
Wrong appt given by nurse Pt. did not follow appointment

Knowledge on preparation staff Knowledge on preparation patient
Appt. book
prospective analysis prospective analysis

Cross sectional prospective
All Unsatisfactory pap smear July 2003 All Unsatisfactory pap smear July 2003
All nurses
100
Appt. book & pap smear form

Self administered questionnaire Self administered questionnaire
100
24 doctors 6 nurses 50
All patients doing pap smear
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Variable Source of data Method of Collection Sample Unit Sample Size
Technique of Observation taking p / s check list

Method of fixation 1.Pap smear form
Performance appraisal
1.Prospective
All doctors
1. All Unsatisfacto ry pap smear July 2003 2. All nurses
50
50
2. Observation 2. Performance check list appraisal Broken slide Pap smears form Prospective
All 100 Unsatisfactory pap smear July 2003

25
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QA PKD Setiu
CHECKLIST
KRITERIA PEMERHATIAN PENGAMBILAN SAMPEL ( Doktor ) Staf yang mengambil spesimen MARKAH
Pakar
2. 3. 4.
MO HO
Ya Ya Ya Ya Tidak Tidak Tidak Tidak
1. Tidak menggunakan lubricant Tanpa kecederaan Cara pengambilan dari servik yang betul Ada discaj
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 9 - 11 April 2007
mestilah 100%
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How much Data To Collect ?
SAMPLING
Sampling Method
Dependent on whether
sampling frame
is available
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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 Sampling
Chances of being sampled unknown a. Convenience sampling b. Purposive sampling

Methods of Sampling
a. Convenience sampling Study units -available at time of data collection

e.g. All ENT patients listed for
operation
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Methods of Sampling
b. Purposive sampling Target a certain group
e.g. Medical BHTs
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Methods of Sampling
Chances of being sampled is known a. Simple random sampling
b. Systematic sampling
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Methods of Sampling
a. Simple Random Sampling Simplest form How: i) Make a numbered list of all study unit in population from which to draw sample
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Methods of Sampling
ii) Decide on sample size iii) Select required number of sampling units using a lottery method or a table of random numbers
Methods of Sampling
b. Systematic Sampling Sample unit chosen at regular intervals from sampling frame Note: risk of bias
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Methods of Sampling
b. Systematic Sampling
How: i) study population 1,200 students of a school ii) sample size selected 100 iii) sampling fraction = ii / i = 100 / 1200 = 1 / 12
Methods of Sampling
Therefore Sampling Interval = 12 Hence randomly choose the number of the first student to be included in the sample by blindly picking 1 of 12 pieces of paper numbered 1 to 12.
Methods of Sampling
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
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Appropriate sample size ?

Bigger sample size NOT EQUAL To better study
Better to increase accuracy of data collection & get representative sample
ANY
Bengkel 4
QA PKD Setiu 9 - 11 April 2007
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Bengkel 4
QA study: Methodology 1 Objectives: General & Specific 2 Type of study 3 Terms ( key words ) definition 4 Inclusion & Exclusion criteria 5 Proposed Indicator and Standard 6 Plan for data collection ( + proposed formats ) 7 Plan for data analysis ( + proposed dummy tables ) 8 Gantts chart 9 Refeences
Examples of QAP Outline

TAJUK 2. Group 3. Problem Identification/ Opportunity for Improvement 4. Prioritization & chosen/refined topic 5. Situational analysis / Literature review 6. Opportunity statement 7. Quality factor analysis / cause-effect analysis 8. Process of care 9. Model of Good Care 10. QA study: Methodology 10.1 Objectives: General & Specific 10.2 Type of study 10.3 Terms ( key words ) definition 10.4 Inclusion & Exclusion criteria 10.5 Proposed Indicator and Standard 10.6 Plan for data collection ( + proposed formats ) 10.7 Plan for data analysis ( + proposed dummy tables ) 10.8 Gantts chart 10.9 References
1/21/2014 QA PKD Setiu 46
Thank You

Step by Step of QAP 3

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DATA COLLECTION

Dr Suhazeli bin Abdullah Family Medicine Specialist KK Permaisuri

Quality Assurance Cycle

Implementation of Remedial Actions

Quality Assurance Study

Identification of Remedial Actions

Plan for Data Collection

Clear overview of what tasks to be carried out

Minimise errors & delays due to lack of planning

Organise human & material resources efficiently

Plan for Data Collection

Schedule different activities carried out

Stages in Data Collection Process

Stage 2: Data collection

Masa Menunggu di A&E

WHERE to collect data: A&E HS

KAJIAN KEPUASAN PELANGGAN

WHAT data to collect

WHAT data to collect

No show patient for ENT op

Masalah Yang Mungkin - Severe NNJ

No NB checklist / guideline POOR IDENTIFICATION OF RISK FACTORS

POOR DETECTION OF NNJ

Inadequate knowledge of parents

INCIDENCE OF SEVERE NNJ

Preference for traditional Rx

POOR COMMUNITY COMPLIANCE

Inadequate poor recording Late referral NNJ cases to MO at HC/Hosp

Inadequate advice to parents

Late/no notification of hosp delivery to QA PKD Setiu health

Stage 2: Data collection

iii) HOW to obtain data

Overlapping Prescription of Cardiac Drugs

HOW to collect data

WHEN to collect data

LOW APGAR SCORE

Newborn with A/S < 7 @ 1 min

WHEN to collect data

Total = 108 cases

DATA: What Where How When

IMPROVING the MX OF DM TYPE II

Good Patient Compliance

Good Family Suppor t

Stage 2: Data collection

Stage 2: Data collection

admission to the ward

Data collection techniques (Primary or secondary data)

Observation Hand washing technique, POP application, Wound dressing

Data collection techniques

Data collection techniques

Data collection techniques

Data Collection Tools

Plan for Data Collection

Wrong appt given by nurse Pt. did not follow appointment

prospective analysis prospective analysis

Appt. book & pap smear form

All patients doing pap smear

Plan for Data Collection

Technique of Observation taking p / s check list

All 100 Unsatisfactory pap smear July 2003

Sekiranya markah 3 atau lebih, doktor berkenaan dianggap mahir

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

(dalam tempoh 1 minit drp. Sapuan pertama)