Rubber stamp templates for improving clinical documentation: A paper-based, m-Health approach for quality improvement in low-resource settings

Kleczka, Bernadette; Musiega, Anita; Rabut, Grace; Wekesa, Phoebe; Mwaniki, Paul; Marx, Michael; Kumar, Pratap

doi:10.1016/j.ijmedinf.2017.10.014

Cited by 21 publications

(38 citation statements)

References 36 publications

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“…The Guidelines Adherence in Slums Project has pioneered the use of rubber stamp templates and smartphones to deliver routine data on primary care delivery in low-resource settings. A previous publication described improvements in clinical documentation for non-communicable diseases 23. This paper first demonstrates improved documentation of care for common infectious conditions.…”

Section: Discussionmentioning

confidence: 80%

“…The Guidelines Adherence in Slums Project aimed to test the usability, acceptability and effectiveness of paper-based clinical documentation tools in improving quality of outpatient care in private sector PHCs serving the urban informal settlements of Nairobi, Kenya 23. While usability and acceptability were assessed using qualitative tools (manuscript in preparation), this paper focuses on effectiveness of the intervention in improving quality of clinical documentation and care.…”

Section: Methodsmentioning

confidence: 99%

“…The Guidelines Adherence in Slums Project used such a ‘paper-to-digital’ approach to generate routine data on patient care delivered in low-resource primary care settings 23. Rubber stamps were used to print templates of clinical case management into paper charts, providing non-physician clinicians in private sector primary healthcare clinics (PHCs) with a standard, evidence-based checklist and documentation tool that could be used during consultations.…”

Section: Introductionmentioning

confidence: 99%

“…Rubber stamps were used to print templates of clinical case management into paper charts, providing non-physician clinicians in private sector primary healthcare clinics (PHCs) with a standard, evidence-based checklist and documentation tool that could be used during consultations. While templates are designed for automatic extraction of data entered in paper using computer vision algorithms on low-end smartphones, the use of templates in and of itself improved quality of clinical documentation for three non-communicable diseases 23. This publication reports on the use of templates to support and deliver routine data on the management of commonly encountered infectious diseases in PHCs.…”

Section: Introductionmentioning

confidence: 99%

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Using rubber stamps and mobile phones to help understand and change antibiotic prescribing behaviour in private sector primary healthcare clinics in Kenya

et al. 2019

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BackgroundAntibiotic use in primary care can drive antimicrobial resistance (AMR) in the community. However, our understanding of antibiotic prescribing in low- and middle-income countries (LMICs) stems mostly from hospital-based studies or prescription/sales records, with little information available on routine primary care practices. We used an innovative, paper-to-digital documentation approach to deliver routine data and understand antibiotic use for common infections in low-resource primary healthcare clinics (PHCs).MethodsRubber stamps were introduced in nine private sector PHCs serving Nairobi’s informal settlements to ‘print-on-demand’ clinical documentation templates into paper charts. The intervention included one mobile phone per PHC to take and share images of filled templates, guideline compilation booklets and monthly continuing medical education (CME) sessions. Templates for upper respiratory tract (URTI), urinary tract (UTI), sexually transmitted (STI) and gastrointestinal infection (GI) management were used in eight PHCs. Information in templates from 889 patient encounters was digitised from smartphone images, analysed, and fed back to clinicians during monthly CME sessions. UTI charts (n=130 and 96, respectively) were audited preintervention and postintervention for quality of clinical documentation and management.ResultsAntibiotics were prescribed in 94.3%±1.6% of all patient encounters (97.3% in URTI, 94.2% in UTI, 91.6% in STI and 91.3% in GI), with 1.4±0.4 antibiotics prescribed per encounter. Clinicians considered antibiotic use appropriate in only 58.6% of URTI and 47.2% of GI cases. While feedback did not affect the number of antibiotics prescribed for UTIs, the use of nitrofurantoin, an appropriate, narrow-spectrum antibiotic, increased (9.2% to 29.9%; p<0.0001) and use of broad spectrum quinolones decreased (30.0% to 16.1%; p<0.05).ConclusionAntibiotic use for common infections is high in private sector PHCs in Kenya, with both knowledge and ‘know-do’ gaps contributing to inappropriate prescription. Paper-based templates in combination with smartphone technologies can sustainably deliver routine primary care case management data to support the battle against AMR.

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Section: Discussionmentioning

confidence: 80%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Using rubber stamps and mobile phones to help understand and change antibiotic prescribing behaviour in private sector primary healthcare clinics in Kenya

et al. 2019

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“…Similar improvements have been reported in studies that have assessed the effect of audit and/or educational interventions on clinical record keeping in other disciplines. [49][50][51][55][56][57] Consistent with these findings, Bowie et al (2012) suggested placing education at the centre of clinical audit enhanced the effectiveness of the process. 58…”

Section: Efficacy Of Clinical Auditmentioning

confidence: 82%

Clinical audit as an educative tool for optometrists: an intervention study in age‐related macular degeneration

Gocuk

Lee

Keller

et al. 2020

Ophthalmic Physiologic Optic

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Purpose Age‐related macular degeneration (AMD) is a major cause of vision loss. This study investigated whether performing clinical audit and receiving analytical performance feedback altered documentation of the AMD care provided by optometrists. Methods Australian optometrists were recruited and completed a survey about their demographics and confidence in AMD care, and a three‐month audit of their practice records using an AMD audit tool (termed the pre‐audit evaluation). After receiving analytical feedback, participants identified areas for improvement and re‐audited their practices after three months to analyse changes in performance (termed the post‐audit evaluation). Paired t‐tests and Wilcoxon signed‐rank tests, as appropriate, were used to compare pre‐ and post‐audit data. Results Twenty optometrists, most practising in Victoria, Australia, completed the study. Participants primarily worked in corporate practice and/or rural settings and had a range of optometric experience (2–40 years). At baseline, participants felt confident in their: knowledge of AMD risk factors (65%), advice to patients about these factors (55%) and management of earlier stages of AMD (55%). Each clinician completed (median [IQR]): 15 [IQR: 10–19] and 12 [IQR: 8–16] audits of unique patient records, pre‐ and post‐audit, respectively. Post‐audit, average record documentation (per optometrist) improved for asking about: AMD family history (94% to 100%, p = 0.03), smoking status (21% to 58%, p < 0.01), diet (11% to 29%, p < 0.01) and nutritional supplementation (20% to 51%, p < 0.01). For clinical examination, compliance with documenting pinhole visual acuity, performing an in‐office Amsler grid (upon indication) and using optical coherence tomography improved post‐audit (p < 0.05). Accuracy of severity documentation improved for earlier stages of AMD (p < 0.05). For earlier stages of AMD, documentation of counselling about modifiable risk factors significantly improved post‐audit (p < 0.05). Aspects well‐performed pre‐audit that did not change included documenting: medical histories (100% at both time points, p = 0.06) and retinal imaging (77% at both time points, p = 0.97). Conclusions Self‐audit with analytical feedback improved clinical record documentation of: AMD risk factors, clinical examination, AMD severity classification and management advice. These findings support a role for audit to improve optometric clinical care of AMD, as evidenced by improved documentation of the AMD care delivered.

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Improving the mechanical properties and curing characteristics of styrene‐butadiene rubber/butadiene rubber composites by incorporating silicon carbide

Zabihi,

Fasihi,

Rasouli

et al. 2023

Polymer Composites

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Thermal conductive filler, silicon carbide (SiC), has been investigated for its effects on the mechanical properties, microstructural properties, physical properties, and kinetic characteristics of styrene‐butadiene‐rubber/butadiene rubber (SBR/BR). SBR/BR‐SiC's tensile strength, strain at break, and toughness were improved by 5 phr SiC content within the composite. Specifically, there was a 44% increase in tensile strength, a 51% increase in strain at break, and impressive 113% increase in toughness. Additionally, there was a notable reduction of approximately ~15% in the compression set. The calculated crosslink density using the Flory–Rehner equation proved that the SiC filler increased the covalent bonds between the polymer chains during the curing reaction. The rheometry results showed a reduction in the scorch and optimum curing times by ~10% via the incorporation of SiC. The addition of 5 phr SiC decreased the curing duration time by 47%. The scanning electron microscopy images taken from the samples at different magnifications showed that the particle agglomeration after SiC = 5 phr was the main factor in reducing the SiC performance in the composite.Highlights Tensile properties of SBR/BR were improved with high thermal conductive SiC. SiC accelerated the rate of vulcanization reaction of SBR/BR. The crosslink density was maximized with the addition of SiC to the compound. Better heat transfer by SiC led to a reduction in the energy consumption of curing. Thermal diffusivity was raised with the addition of SiC to the compound.

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Rubber stamp templates for improving clinical documentation: A paper-based, m-Health approach for quality improvement in low-resource settings

Cited by 21 publications

References 36 publications

Using rubber stamps and mobile phones to help understand and change antibiotic prescribing behaviour in private sector primary healthcare clinics in Kenya

Using rubber stamps and mobile phones to help understand and change antibiotic prescribing behaviour in private sector primary healthcare clinics in Kenya

Clinical audit as an educative tool for optometrists: an intervention study in age‐related macular degeneration

Improving the mechanical properties and curing characteristics of styrene‐butadiene rubber/butadiene rubber composites by incorporating silicon carbide

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