Improving estimation of prevalence of hepatic encephalopathy among liver disease patients on the gastroenterology ward at Mulago hospital.
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Background: Liver disease is a major cause of morbidity and death worldwide. Hepatic encephalopathy is a common complication of liver disease. It has significant impact on a patient's quality of life and recently has been associated with increased hospitalizations and death. Doctors on the GI ward would like to improve management of patients with HE. To do this, they need to know the current burden of the disease on the ward. Unfortunately, there is no current data on the prevalence of HE on the GI ward. The data from patient medical records can provide information on prevalence of HE on the GI ward, however, these medical records aren’t adequately completed. If used in the current state, the estimate obtained will be inaccurate. Objective of the study: To obtain an improved estimate of the prevalence of HE among patients with liver disease admitted on the GI ward at Mulago Hospital. Methods: The study was a cross-sectional study with quality improvement components in the process of data collection. It was carried out on the GI ward at Mulago hospital. The QI methods used included: process mapping, root cause analysis, QI intervention and Plan Do Study Act cycles to improve the completion of the face sheets and monitoring charts where we collected our data so as to obtain an improved estimate from these records. 265 patient medical files with documented liver disease diagnosis on the face sheet were sampled by consecutive sampling after the patients had been discharged from the GI ward. A data extraction tool was completed. This data was summarized weekly and plotted on run charts. Results: Root causes of inadequate documentation of HE diagnosis and other fields on the face sheets were multi factorial and included health worker related, environmental, system related and equipment related factors. With the education, the knowledge of the QIT on completion of the face sheets and monitoring charts improved to some significant extent but needs to be regularly reinforced to be maintained. With continuous reminders and close supervision, the completion of the face sheets improved. From these face sheets; the prevalence of HE among liver disease patients was 22.3%. The most common type of HE was type C. Conclusions: The main cause of inadequate completion of the face sheets and monitoring charts is lack of supervision of the health care team by the physicians on the GI ward. With the education intervention, the knowledge of the QIT and completion of the face sheets improves but needs to be regularly reinforced. The prevalence of HE among liver disease patients was 22.3%. Recommendations: Close supervision and continuous reminders of the health care team by the physicians on the GI ward is recommended to maintain adequate completion of the face sheets and monitoring charts. The various ward units and hospital at large should have regular meetings to utilize the data on prevalence from weekly run charts. We recommend the pharmacy stock medicines for HE for at least 5 patients every week.