Improving Diabetes Nephropathy Screening Among Patients Outpatient Clinic at JM Kariuki Memorial County Referral Hospital, Nyandarua County, January to August 2023
Author: Michael Ruitururi
At the heart of Nyandarua County’s JM Kariuki Memorial County Referral Hospital, an exceptional team led by the dedicated Michael Ruitururi has embarked on a transformative mission. Their objective is as straightforward as it is profound: to enhance the screening process for diabetes nephropathy among patients at the hospital’s outpatient clinic. In a world where approximately 843 million individuals battle nephropathy, and where Kenya witnesses a staggering 35.3% prevalence of this condition among diabetic patients, the stakes are undeniable.
The backdrop to this story lays out a stark reality. At JM Kariuki Memorial County Referral Hospital, the clinics that cater to the health of the community’s diabetic patients registered a mere 15% of patients screened for nephropathy between January and March. This baseline statistic painted a sobering picture, with only 72 out of 458 patients benefiting from this crucial screening during this period.
The gravity of this situation sparked a ripple of change, driven by the desire to improve. Michael Ruitururi and a multidisciplinary team, equipped with insights from quality improvement training provided by ACQUIRE and Kijabe College of Health Science, took up the challenge. Their mission was not just to improve this percentage; it was to catapult it from 15% to a staggering 95% of patients attending diabetic clinics.
Charting the Path to Progress
The journey toward transformation commenced with a comprehensive understanding of the problem at hand. Data was meticulously collected from the clinic, with inputs from five healthcare workers and insights from fifteen patients on nephropathy screening. A methodical approach was adopted, using purposeful sampling techniques.
The collected data wasn’t just numbers; it was the foundation on which change would be built. This raw material took the form of sticky notes, each one representing a facet of the challenge. The data was then meticulously grouped and structured through the powerful lens of Pareto charts, revealing the key issues.
Two paramount challenges emerged from the data. The healthcare workers grappled with an overwhelming workload, a weight that seemed to eclipse the prospect of comprehensive nephropathy screening. Equally significant was the revelation that patients often lacked awareness about the critical importance of nephropathy screening.
The Pursuit of Progress
With the challenges identified, a root cause analysis was the next logical step. A fishbone diagram, a powerful tool in quality improvement, revealed the four key drivers behind the low screening rates. These were the lack of a screening tool, inadequate awareness and education, and a scarcity of capacity-building initiatives.
Armed with these insights, the team initiated four key interventions. The introduction of a nephropathy screening tool within patient files paved the way for improved record-keeping. Simultaneously, monthly continuous medical education sessions were conducted for medical officers and clinicians, reinforcing the significance of screening.
The Result: A Triumph for Patient Well-being
The power of these interventions revealed itself in the results. Biweekly tracking using the screening tool as a guide illuminated the way forward. It became evident that the screening tool was missed in 10 patients, leading to the timely introduction of this missing link. In the spirit of efficiency, reorganization and the elimination of one unnecessary step further streamlined the process.
The outcome was nothing short of remarkable. From a meagre 15%, the number of patients screened for nephropathy soared to a substantial 60% from May to August 2023. The impact was undeniable, as more individuals received the crucial screening they needed.
A Journey Unfinished, but Progress Uninterrupted
As the story unfolds, it becomes evident that the journey is far from over. With all key interventions happening simultaneously, it is challenging to determine which was the most effective. This narrative underscores the necessity of continuous monitoring and ongoing sensitization for healthcare workers and patients. In this pursuit of progress, teamwork, a shift in attitude, and job satisfaction will play pivotal roles in the successful implementation of interventions.
Michael Ruitururi and his dedicated team at JM Kariuki Memorial County Referral Hospital have illuminated the path to transformation. Their journey underscores the unyielding commitment to patient well-being and the unshakable belief that in healthcare, change is not just possible; it is a responsibility. As the pursuit of excellence continues, their story serves as an inspiration to all.
Read More about the QI story below:
This is part of the storytelling contest submission for World Patient Safety Month. Read more here.