Tuesday, August 18, 2009

Stores , records and DHIS

Table of Contents
Unit 6. 2
Stores, Records and the District Health Management Information System (DHIS) 2
Learning Objectives: 3
1. Stores: 3
Chart of Vital Signs. 6
Vital Signs. 6
Definition 6
Purpose 6
Sample of a Basic Vital Signs Chart 6
Birth Register. 8
Death Registers. 8
Medico-legal Register. 8
Postmortem Register. 8
The District Health Management Information System (DHIS) 9
Introduction. 9
DHIS Vision. 9
DHIS Objectives. 9
DHIS Instruments and Tools. 12
Class room evaluation. 13
Notes. 16


·
Unit 6
Stores, Records and the District Health Management Information System (DHIS)
Learning Objectives:
After completing unit 6 dispenser students will be able to:
define different types of stores and their purpose
manage different types of stores, e.g. medicine stores, general stores etc. according to prescribed government procedures
demonstrate skills and knowledge about how to manage store registers, stock ledgers and other accountable records according to prescribed government procedures
define the purpose and importance of DHIS
identify relevant tools and instruments of DHIS (OPD registers, abstract forms, patients records etc.) and their importance
correctly fill out relevant DHIS forms and reports
define the importance of records vis-à-vis audit.



Activities
Visit a store, show stacking procedures and records to dispenser students
Brainstorm
What will happen if your store is disorganized and dirty?
How would you make sure that you find an item that was received on a particular date?
1. Stores:
Medicines, equipment, linen, furniture, stationery and other general items of use in health facilities are stocked in specialized places called stores. The bigger the health facility the bigger are its stores and the bigger is the variety of items that stores would hold. Managing stores, stocks and supplies has become highly technical and is called supply chain management.
Generally, government procedures on managing stored are quite elaborate and well-documented. All public sector store keepers are required to follow these. However the general principles of a simple store management are:
· Security
o Stores contain accountable items that means that the storekeeper is responsible for the stock. Therefore, it is essential that the security of store is adequate so that pilferage and deterioration of the items stocked is ruled out. Proper attention should be given to doors, windows and walls with a view to ensure safety and security. Procedures for locking, unlocking doors and access to stores should be well-documented so that an audit trail is developed. The audit trail should have records of who has been accessing store at what time.
· First coming items leave the store first (First In First Out).
o This means that we need to keep a track of the receipt date of all items present in the store. The entry in stock register should be made mentioning the batch number and date of expiry on the top corner of the page each time the stock is received. If we have received three deliveries of an item in different quantities on three different dates, while issuing this item, we will look at the receipt date of each and will issue the one that we had received first.
· Cleanliness
o We must keep our stores clean as cleanliness keeps items in stock in good shape and gives a good impression of the performance of the storekeeper.
· Stacking or Storage Arrangements:
o Stacking and placement of stored items should be such that our movement within the store, physical inspection and drawl of stored items is easy and quick. Orderly stacked items make it easy for us to find things whereas disorganized store looks like a junkyard. We should follow the stocking arrangements that our healthcare facility is following, e.g. bin card system or computerized system etc.
· Records or Stock Ledgers
o We use stock ledgers or stock registers for keeping track of ‘receipt and issue’ of different items. The storekeeper is responsible for safe keeping and updating these records. All items or deliveries received are entered in these registers with dates and other details. Similarly, we make relevant entries when we issue items to others.
o All stock ledgers and registers should have page numbers; stock register without page numbers is incomplete and open to tampering. As a rule the incharge of the facility or stores department should give a certificate on the first page of the stock register certifying the page numbers with his/her name clearly written, signatures, date of the certificate and office seal.
o All store records are auditable documents. Therefore it is the duty of the storekeeper to ensure that they are safely locked and unauthorized persons should not have access to them.
· Maintaining Record of Transactions:
o When we receive or issue an item from our store, we are making a transaction. As a rule all transactions must have a written document that accurately records the transaction. Usually, a storekeeper receives a request in writing from a person who is authorized to sign or approve such requests. After issuing items requested for, the storekeeper must take a written receipt. Usually, these receipts are taken on the stock ledgers. However, separate forms or plain papers could also be used for this purpose.
· Audit and physical verification
o Stock ledgers are auditable documents and audit teams whether internal from the healthcare facility or external from the audit office are authorized to check if the ledgers are updated and the stock shown in the register or ledger matches what is physically present in the store. A mismatch between register and physical stock can invoke disciplinary procedure.

Chart of Vital Signs
Vital Signs
Definition
Vital signs, or signs of life, include the following objective measures for a person: temperature, respiratory rate, heart beat (pulse), and blood pressure. When these values are not zero, they indicate that a person is alive. All of these vital signs can be observed, measured, and monitored. This will enable the assessment of the level at which an individual is functioning. Normal ranges of measurements of vital signs change with age and medical condition. (please see the chart below for normal values)
Purpose
The purpose of recording vital signs is to establish a base line on admission to a hospital, clinic, professional office, or other encounter with a healthcare provider. Vital signs may be recorded by a nurse, a doctor or a dispenser or another healthcare professional. Dispensers could be asked to prepare a chart of vital signs and record them. Recorded data and information from the vital signs chart are used for interpreting and identifying any abnormalities from a person's normal state, and of establishing if current treatment or medications are having the desired effect. Usually the doctor will instruct on the frequency of recording vital signs, i.e. hourly, 4-hourly or six hourly etc. The person recording vital signs should follow these instructions. Each time vital signs are recorded, the person recording those should sign and record date and time.
Sample of a Basic Vital Signs Chart
Patient’s name and address:
Diagnosis:
Date of admission
Ward:
Name of incharge doctor and nurse:
Date:
Instructions:
Time & Date when recorded










Temperature










Pulse Rate










Blood Pressure










Breathing Rate























Birth Register
Birth register are kept in labor rooms. Incharge gynecologist, WMO, nurse, LHV or dispenser may record entries of births in this register. Technical notes are usually recorded by the person supervising the delivery. Additionally, full address and other contact details of the mother are also entered. Dispensers are usually asked to assist while the supervising person is making entries in the birth register.
Death Registers
Death registers are ward specific in DHQ, THQ and tertiary hospitals. However, at RHCs there is only one death register. For ward specific death registers there is usually a hospital death committee which reviews deaths registers on a weekly basis.
Medico-legal Register
Medico-legal registers are kept at tertiary, DHQ and THQ hospitals and RHCs. Usually there is one register for WMO and one for MO. All entries in these registers are made by doctors. Dispensers only assist doctors when they are carrying out medico-legal examination.
Postmortem Register
Postmortem registers are kept separately by WMOs and MOs. All entries in these registers are made by doctors. Dispensers only assist doctors when they are carrying out postmortem examination.
The District Health Management Information System (DHIS)
Activities
Show DHIS tools and instruments and records to dispenser students
Take dispenser students to the office of district coordinator for DHIS and show them how data is compiled and analyzed, and finally converted into information.
Show dispenser students registers and records related to poisons, births & deaths, medic-legal cases and postmortem. Highlight procedures for making entries in these registers and their importance
Show them a chart for recording vital signs and explain its importance, practice filling out this chart in practical training sessions.
Brainstorm
How will you use DHIS information?
What will you do if you find out that you have missed your monthly targets?
Introduction
Success of departments, organizations and health facilities depends on their ability to collect and use information to support their planning, management and decision making. The value attached to information could be appreciated from the fact that the world’s total store of knowledge is doubling every four years. However, we need to know how to find appropriate information, analyze it correctly and draw meaningful conclusions. Thus, the collection and use of right type of information in the health sector cannot be overemphasized.

Government of Pakistan has introduced DHIS for collecting information about the performance of health facilities and districts.
DHIS Vision
To improve healthcare services through evidence-based planning & management of services. Improved service delivery will contribute to the improvement of health status of the population
DHIS Objectives
To provide information for management and performance improvement of the district health system.
More specifically, the DHIS:
· provides selected key information from first level health facility (FLCF), Vertical Programs, Secondary Hospitals and sub-systems such as logistics, financial, human resource and capital asset management systems for improving the District Health System’s performance.
· caters to the important routine information needs at the federal and provincial levels for policy formulation, planning and monitoring & evaluation of health programs.
DHIS enables a HF or a collection of HFs or a district health system to regularly collect and analyze data in a consistent and planned way to demonstrate progress in achieving its important results using well thought out and properly defined measures. This contributes to monitoring and evaluation process.
Monitoring and evaluation (M&E) is an ongoing process to find out that a particular health facility is properly doing what it is meant to do. It also checks that progress is being made towards achieving targets and results. DHIS is a very good tool for M& E. It looks at the performance of a HF or a district and tells whether it is satisfactorily progressing towards its targets or it has achieved its targets.
Figure 1 below illustrates this process. In monitoring & evaluation we plan an activity ( e.g. at HFs) è then we do itè then we review our progress in that activity after sometime to see if we are in the right direction and are progressing according to our plan è then at the end of a particular period (usually 1 year) è we evaluate the activity to see if we have achieved our targets that we had given in our plan. DHIS gives us good information about how we are progressing towards our targets. Therefore, we should know our targets and review our DHIS data and information on a monthly basis at our health facility with our facility incharge.

Figure 7
DHIS Instruments and Tools
The following DHIS tools and instruments are present at healthcare facilities. As dispenser students we should be familiar with them.
DHIS Instrument No.
DHIS Instrument
DHIS – 01 (R)
Central Registration Point Register
DHIS – 02 (F)
OPD Ticket
DHIS – 03 (R)
Outpatient Department Register
DHIS – 04 (F)
OPD Abstract Form
DHIS – 05 (R)
Laboratory Register
DHIS – 06 (R)
Radiology/Ultrasonography Register
DHIS – 07 (R)
Indoor Patient Register
DHIS – 08 (F)
Indoor Abstract Form
DHIS – 09 (R)
Daily Bed Statement Register
DHIS – 10 (R)
Operation Theater (OT) Register
DHIS – 11 (R)
Family Planning Register
DHIS – 12 (C)
Family Planning Card
DHIS – 13 (R)
Maternal Health Register
DHIS – 14 (C)
Antenatal Card
DHIS – 15 (R)
Obstetric Register
DHIS – 16 (R)
Daily Medicine Expense Register
DHIS – 17 (R)
Stock Register (Medicine/Supplies)
DHIS – 18 (R)
Stock Register (Equipment/Furniture/Linen)
DHIS – 19 (R)
Community Meeting Register
DHIS – 20 (R)
Facility Staff Meeting Register
DHIS – 21 (MR)
PHC Facility Monthly Report Form
DHIS – 22 (MR)
Secondary Hospital Monthly Report Form
DHIS – 24 (YR)
Catchment Area Population Chart











Class room evaluation


Student: _________________________ ID: __________________________

Teacher: _________________________ Unit 6

Date: ________________________


Define monitoring and evaluation?
________________________________________________________________________________________________________________________________________________________________________________________________________________________


What is DHIS?
________________________________________________________________________________________________________________________________________________


What do we do with DHIS data?
________________________________________________________________________________________________________________________________________________________________________________________________________________________

What will happen if we make wrong entries in the DHIS forms?
________________________________________________________________________________________________________________________________________________________________________________________________________________________


How should we manage a store?
________________________________________________________________________________________________________________________________________________________________________________________________________________________

What are general principles of store management?
______________________
______________________
______________________
______________________

Store records are not auditable.
True False


We should not review our DHIS data.
True False

DHIS data does not tell us if we are making satisfactory progress towards our targets
True False


We should not worry about the results of the activities of our health facility.
True False

DHIS data gives us information that the health facility team can used for planning its future activities.
True False

Notes

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