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Skip to 0 minutes and 13 secondsBy the end of this presentation you should be able to: - Apply the principles and details of recording patient information, surgical output and surgical outcome. - Assess the information collected and provide guidance for the surgical team activities. Record keeping is the charting of activities done and the archiving of this information.

Skip to 0 minutes and 34 secondsRecord keeping is carried out in order to manage: - Individual patient care. - How much surgery has been done - this is measured through output and coverage figures - How good the surgical service was - this is measured through outcome figures. Good recordkeeping is an active process. A trained person has to collect the information and store it correctly. The collected information is assessed at regular intervals by a manager or co-ordinator who prepares a report. This is known as monitoring. Monitoring can be carried out every month or even after every outreach. Ideally, the manager also sends feedback to the trichiasis surgery team on the trends and issues identified in the monitoring report.

Skip to 1 minute and 17 secondsThe team can use this information to improve their service. It can often be challenging to ensure that suitable information is collected at the right time and that a complete and correct record is kept. - Poor record keeping examples include: - Incomplete or missing records. - Illegible clinical information. - Records on loose paper that are not archived. - Incorrect data collected. Poor record keeping leads to serious consequences

Skip to 1 minute and 44 secondsfor trichiasis surgery services, such as: - Inadequate co-ordination and continuation of care - Poor decision making capacity - Lack of accountability, and - Inaccurate statistics in reporting To monitor trichiasis surgery services,

Skip to 2 minutes and 0 secondsthree sets of individual patient records need to be kept: - Pre-surgical records - Surgical records - And, post-surgical records All data are standardised. That is, the information collected about each patient is the same. It is best to assign the responsibility of recording and collecting patient record information to one member of the trichiasis surgery team. Data can be recorded on paper, or electronically. At the end of each outreach - within a day - all the information should be sent to the local health worker supporting the follow up. It is also sent to the team's supervisor or manager within a week. The manager verifies and analyses the data before passing it on to national coordinators and sending feedback to the team.

Skip to 2 minutes and 46 secondsPatient information is collected on location, age, gender, address and contact details for follow up.

Skip to 2 minutes and 54 secondsPre-surgical information is collected on: - Presence or absence of scar indicating previous surgery on the upper eyelid. - Severity of trichiasis. That is the number of upper eyelid eyelashes touching the eyeball. - Evidence of epilation of in-turned eyelashes. - Presence or absence of lower eyelid trichiasis. It is important that the surgical team also obtain, record and archive each patient's consent for surgery. Analysing the pre-surgical records. The supervisor or outreach manager analyses the pre-surgical records to generate information on the acceptance rate and coverage of the trichiasis surgery service. They do this for each community, sub-district and district. Coverage is calculated for persons.

Skip to 3 minutes and 40 secondsCoverage equals the number of trichiasis surgeries done, divided by the total number of patients with trichiasis, multiplied by 100 The acceptance rate equals the number of patients who consented to have surgery divided by the total number of patients with trichiasis who were offered surgery, multiplied by 100. Acceptance can be further assessed by gender

Skip to 4 minutes and 4 secondsManagers use coverage and acceptance rate information to: - assess whether enough surgeries are being done to eliminate trachoma. - assess how successful community sensitisation activities can be sustained. - encourage the trichiasis team to carry on. The target for the elimination of trachoma in an area is a prevalence of trichiasis of less than 1 in 1000 people [<0.2% in adults aged 15 years and above]. The generally accepted minimum target for trichiasis surgery outreach campaigns is 15 surgeries per surgeon per day. This target may be different in your area as it relates to the local prevalence of trichiasis.

Skip to 4 minutes and 39 secondsIf the number of surgeries being carried out is below target, managers discuss with the team whether this is due to inadequate community mobilisation or lack of sufficient manpower and materials. They also consider ways to improve If the number of surgeries being carried out is above target, managers feed this information back to congratulate and motivate the team on the work done. Surgical records.

Skip to 5 minutes and 7 secondsThe information we collect in the surgical record includes: - The name of operating surgeon. - Eye being operated on. - Type of operation (that is bilamellar, [or] posterior lamellar, tarsal rotation). - If a clamp was used. - Type of suture used. Information on any surgical complications

Skip to 5 minutes and 25 secondsis also collected: - Excessive bleeding. - If the margin fragment severed. - If globe puncture occurred. - Other. Finally, information is also collected on whether oral azithromycin or topical tetracycline are given to the patient. The surgical record[s] informs surgeons about their own complication rate and also about the most common complications they are experiencing. Ideally, this information is verified with a supervisor and training support is provided to surgeons as needed. Sometimes surgeon payments are also linked to numbers of surgeries done. Post-surgical records. Follow up data on each patient is recorded at day 1, 7-14 days and between 3 and 6 months after the operation. At each occasion it is important to collect data

Skip to 6 minutes and 14 secondson the presence or absence of trichiasis: - The number of eyelashes touching the eyeball and - If there is any evidence of [recent] epilation of in-turned eyelashes. Information should also be collected

Skip to 6 minutes and 25 secondson the presence or absence of: - Infection or discharge. - Granuloma. This the feeling a foreign body, or a visible lump, on the inner-side of the eyelid. - Eyelid contour abnormality. - Over-correction. It's important for managers to share data from post-surgical follow up with the surgeon and team, and to reflect on any action required. For example, if at the 7 day visit it's found that there's a high percentage of cases with wound infection, then the sterilisation process used by the surgical team should be re-assessed. And if a high percentage of overcorrection is being found then the surgeon may need refresher training.

Skip to 7 minutes and 7 secondsKey reporting activities for managers: 1 Send data to local authorities and supervisors to verify 2 Share feedback on results from data with the surgical team and with individuals in charge 3 Take informed action to improve and enhance service delivery Good data can also be used to reinforce support from funders. In summary Record keeping is an essential component of a trichiasis surgery team's work. It should be done by a dedicated, trained person using pre agreed, standardised data forms. The forms may be paper-based or electronic. Managers must analyse and verify the data to guide and improve service provision. Data trends guide trachoma programme activities towards achieving the trachoma elimination target of less than 1 person with trichiasis per 1000 total population.

Record keeping and reporting for trichiasis surgery

To achieve high coverage and high quality in a trichiasis surgery service, we need to measure how we are doing.

Data collection and record keeping happen together:

  • Patient registration forms: Information to trace and locate each patient. Data collected include: name, age, sex, district, sub district, village, location, compound
  • Facility summary register: Monthly data summary for each facility. Shows numbers of surgeries done, proportion given post-operative azithromycin, number of women and men that received surgery, and so on
  • District summary register: Each district office collects monthly data from each facility and calculates the total number of surgeries done per month in the district
  • Regional summary register: Each region records monthly totals from all constituent districts
  • National summary register: Data from all regions are collated and used to report to funders and at global level

The TT case manager (see step 2.12) assists with all of these functions.

Nurse working on statistics Realising for the first time what statistics mean. © Victoria Francis CC BY-NC (Click to expand)

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Eliminating Trachoma

London School of Hygiene & Tropical Medicine

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