Used infusion bags of physciological saline or antileishmanial Amphotericin B
Used infusion bags of physciological saline or antileishmanial Amphotericin B

Practicalities to consider (check-list)

Previous steps have covered a wide range of topics, describing best practice in an ideal setting.

As Dr Adera describes in Step 2.12, the diagnosis and treatment of VL can be challenging. For example managing patients with poor access to care such as seasonal workers or the availability of a functioning health care system. These are important topics that be will covered in more detail in week 4.

This step highlights some of the core practicalities of use for diagnostic and treatment tools covered this week. These practical aspects are essential for the delivery of high quality care: quick, practical and accurate diagnosis and successful treatment outcomes. The systematic use of guidelines, protocols for the use of tests but also the life cycle of reagents and materials (from sourcing to waste disposal) should be highly encouraged.

Where possible high standards of laboratory procedures should be maintained and adherence to Good Clinical Practice. This includes recording and reporting of results including adverse events, maintaining patient records and confidentiality and ensuring quality control. The quality standard of any reagents, tests, kits and drugs that are to be used in the clinic also has to be checked. Sub-standard materials can have an impact on test results, response to treatment and treatment outcome. They may also cause toxicity to patients. Illustrated below are very simplified checklists that can be used in the clinic to facilitate adherence to best practice.

Example of a diagnostic laboratory check-list for an RDT kit:
- Is the patient sample clearly marked/easily identifiable?
- Are all the laboratory reagents and materials available and in date?
- If using a kit, make sure it is not a fake
- Has the kit been stored correctly?
- Have you noted the kit batch or ID number?
- Is a Standard Operating Protocol (SOP) available for the test? This may be in the form of instructions within the test kit.
- Is appropriate waste disposal available?
Example of anti-leishmanial drug check list:
- Is the drug from an accredited manufacturer and supplier? (You can look in these links for information on manufacture and supply of anti-leishmania drugs http://www.who.int/leishmaniasis/research/en/ and WHO essential medicines list per country - http://www.who.int/selection_medicines/country_lists/en/)
- Check the expiry date of the drug
- Is the packaging still intact?
- Has the drug been stored correctly? E.g. cold chain for AmBisome (©Gilead)
- Note the batch number of the drug
Drug preparation
Are there clear instructions for the storage, preparation and administration of the drugs? They must be available to the respective personnel responsible.
- Is the dose calculation correct?
- Is appropriate waste disposal available?
Patient information and compliance
- Is the patient or person responsible for the patient fully aware of the reasons and risks of the procedure, and has given consent (verbal or otherwise) to the procedure?
- Are results from diagnostic testing recorded and reported to the relevant clinicians, Health Care Provider and patient? (Has the patient been given a (written) discharge summary explaining the diagnosis and treatment to take home in the case of future complications?)

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This article is from the free online course:

Control and Elimination of Visceral Leishmaniasis

London School of Hygiene & Tropical Medicine