Implementation of the Pocketbook of Hospital Care for Children

Implementation

In 2005 the WHO produced the “Pocket Book of Hospital Care for Children” in an effort to provide a global resource for addressing the quality of care in poorly resourced hospitals.  These pages are designed to provide an overview of the path to implementation of the guidelines.

A survey was carried out in 2011 to ascertain worldwide distribution, uptake, and use of the WHO Pocket Book of Hospital Care for Children. Click on the link below to read the findings.

Suggested Approach to Implementation

A co-ordinated effort between ministries of health, donor partners, paediatric professional associations and academic institutions is needed for effective implementation of the Pocketbook. Endorsement from governmental authorities (e.g. ministries of health) is vital for this to occur.

Global use of the WHO Pocket Book of Hospital Care for Children: a systematic survey

Michelle Y. Li1, Julian Kelly1, Rami Subhi1, Wilson Were2, Trevor Duke1

1Centre for International Child Health, University of Melbourne, Royal Children’s Hospital, Parkville, Victoria, Australia, and 2Department of Child & Adolescent Health & Development, World Health Organization, Geneva,Switzerland

Countries have taken different approaches to implementation of the Pocketbook.  Countries’ strategies have involved several or all of the following steps:

  • Assessment of quality of care via internal or external review.  Many countries have conducted baseline assessments of the quality of paediatric care, aiming to identify the problems and establish a baseline for evaluation.  WHO has instruments to assist with this process of assessment which has been used across different settings
  • Defining the potential role for the Pocketbook and how it may relate to existing resources, guidelines and child health programs is also important.
  • Development of standards. The adoption of a minimum standard of care via evidence based medicine and practice guidelines is critical to the process.
  • Adaptation +/- translation. Ensuring that the Pocketbook is available in the local language is an essential step for ensuring widespread uptake and application at all levels of health care. Some countries may choose initially to translate directly without any adaptation for local circumstances or disease epidemiology and decide later on the need for adaptation once experience with the Pocketbook has been gained. Alternatively, adaptations may be undertaken during translation to optimise the local relevance of the Pocketbook. Generally a meeting of major stakeholders to introduce the Pocketbook to the Government, MoH, Universities, National Paediatric Association, etc, followed by formation of an adaptation working group and consensus meetings to agree on local modifications is required.
  • Training. The Pocketbook training is a four-day case based workshop to train nurses and doctors in how to use the WHO Pocketbook, and also in how to use the CD for training in their hospital (Training tools). This training includes feedback from hospital assessments in the country, the development of an approach to patient care, video materials, case-based teaching on use of the Pocketbook in clinical practice, with practice in hospital wards, and group discussions on improving hospital care. The training plan should include: Identifying core trainers
    • Identify targets for training, including doctors, nurses and medical assistants
    • Reviewing the training materials and workshop plan, making any necessary adaptations and deciding where and how the training should be conducted to maximise attendance and ensure sufficient patients are available for practice sessions on wards
  • Integrating the Pocketbook with education programs. Integration of the Pocketbook and its training materials into existing educational programs is essential for ensuring longer term sustainability. These programs may include undergraduate medical, nursing or medical assistant curricula or post-graduate paediatric medical or nursing curricula. 
  • Monitoring and audit to assess progress and identify priorities for improving care. At a minimum it is important to understand who has been trained, where training and books have been delivered and how training has been received. The training workshops represent a new way of learning and teaching for many countries, and some adaptations to the training plan may need to be made over time, such as allowing more time for participants to learn. In other situations, where resources allow, following up training with further assessments of hospitals or measuring hospital performance against minimum standards of care may be an effective way to understand the impact of the training, or to provide ongoing feedback and supervision to trainees and hospitals. In most cases, the most important feedback will be reinforcement of the use of the Pocketbook through everyday clinical work, and for this it is important that senior clinicians are engaged with the training activities.
  • Addressing other obstacles to quality of hospital care.  These may include:
    • Improving data recording and standardised reporting of hospital outcomes (See Audit section for ready to use downloadable database)
    • Improving basic technology such as oxygen therapy and equipment for neonatal care
    • Referral guidelines.

For more information regarding implementation and technical assistance please contact Trevor Duke, Centre for International Child Health trevor.duke@rch.org.au