Development and Monitoring the Key Performance Indicators of the Quality of Care for Patients with Cleft Lips/Palates at Srinagarind Hospital.

BACKGROUND: Congenital deformities, such as cleft lips and/or cleft palates (CLP), have high incidences in the Northeast of Thailand. These birth defects can affect patient's quality of life. CLP patients need crucial and long-term treatments by a multidisciplinary team starting from prenatal stage to late adulthood. Patients and their families should involve in their own care, and their care objectives should correspond with healthcare providers. Besides the clinical outcome of interdisciplinary team, key performance indicators (KPIs) need to be developed in the hospital service unit in order to improve quality of care and treatment outcomes. OBJECTIVE: 1) to establish KPIs in hospital service units, and 2) to develop the information system to collect, analysis and improve the quality of CLP care. MATERIAL AND METHOD: A nurse coordinator was appointed in the Tawanchai Center to coordinate care. The three periods were conducted for the nurse coordinator to work with nine service units in Srinagarind Hospital for consensus on both qualitative and quantitative data to be used as service unit quality measurement. RESULTS: Thirty one KPIs from nine service units were established, collected and analyzed during a four-month period in 2014. The 20 KPIs achieved the unit targets. Two PKIs of the rates of complication with anesthesia during/after surgery in the first 24 hours and the rates of patient/caregiver's satisfaction in acquiring information from the officer were improving. There were 11 KPIs that did not achieve the targets. The coordinator nurse of the Tawanchai Center discussed with the service unit for the cause and how to improve the outcome. CONCLUSION: The monitoring KPIs will lead to improvement of outcome for better patient quality as well as benchmarking with other hospitals of Cleft Center. The KPIs from hospital service units with the monitoring and analysis of information by the nurse coordinator will enhance and lead to improvement of the quality of the patients and family centered care process.

Treatment of 4-5 year old patients with cleft lip and cleft palate in Tawanchai Center: prevalence and type of associated malformations.

BACKGROUND: Patients with cleft lip/palate may have other associated malformations but the reported prevalence and type of associated malformations varied between different studies. OBJECTIVE: To report the prevalence and the type of associated malformations in Northeastern Thai patients with cleft lip/palate. MATERIAL AND METHOD: A retrospective study of 123 cleft lip/palate patients aged 4-5 years was carried out at the Tawanchai Cleft Center, Khon Kaen University during the periodfrom October to December 2011. Data were collected by reviewing the patients medical records. RESULTS: Seventeen (14%) of the 123patients had associated malformations. Four (21%) of the 19patients with cleft palate, eleven (15%) of the 74 patients with clefts lip and palate, and two (7%) of the 30 patients with cleft lip had associated malformations. The organ systems affected by associated malformations were cardiovascular system (41%), craniofacial anomaly (23%), skeletal system (12%), urogenital system (12%) and central nervous systemn (12%). Atrial septal defect and tetralogy ofFallot were most common associated cardiovascular malformation found. CONCLUSION: The high prevalence of associated malformationsfound in patients with cleft lip/palate emphasizes the needfor a thorough screening of associated malformations and congenital heart disease ofall cleft lip/palatepatients.

The promotion of exclusive breastfeeding in infants with complete cleft lip and palate during the first 6 months after childbirth at Srinagarind Hospital, Khon Kaen Province, Thailand.

BACKGROUND: Breastfeeding is especially important for infants with cleft lip and/or cleft palate because it helps prevent nasal septum irritation, decreases the number of ear infections, and provides a sort of psychologically support for the postpartum mothers. It is difficult for a baby born with a cleft lip and/or cleft palate to suck milk out of the breast or bottle. OBJECTIVE: This study aimed to 1) promote exclusive breast-feeding in infants with CL-CP during their first 6 months after delivery and 2) examine risk factors related to the success of exclusive breastfeeding. MATERIAL AND METHOD: A counseling session provided by a special trained nurse is arranged for the parents of these infants as the earliest after birth. The mothers were advised that the best breastfeeding position either cross cradle or football position. The mothers were instructed to support their breasts with four fingers underneath and press their thumb on top to squeeze breast milk to help the babies with CL-CP get enough milk. The breast squeezing should be related to baby's sucking, swallowing and breathing rhythm. The infant weight gain after birth, their comfort, 6-8 urine per day, and 1 - 2 stool per day were used as the indications of breastfeeding success. RESULTS: Twenty infants were included in this study. A follow up after hospital discharge was set at 1 week 1, 2, 3, 4 and 6 months to provide continuously breastfeeding support for the mothers. After the 6-month period, we found that 2 infants were exclusively breastfed for 6 months and continued to have breast milk until 15 and 18 months of age, 2 infants had breastfeed for less than 2 months, and 16 infants for 3-4 months. Employment status played an important factor for the breastfeeding success among the mothers of CL-CP infants. The only 2 mothers able to provide 6 months exclusive breastfeeding did not work while the mothers who could not continue their breastfeeding reported that they felt very exhausted having to go to work and breastfeed their babies when they returned back home. CONCLUSION: This study revealed that exclusive breastfeeding for CL-CP infants can be achieved when the relationship between infants, parents and their families were established.