E-DRUG: Flow diagrams for nurses (2)
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Wilbert,
When I first saw the Essex flow charts in British Medical Journal in about
1977 I thought they would be the answer. I wrote to him and he sent me
duplicated flow charts to try out in Zimbabwe. I introduced them at
District Hospital level and really pushed the paramedical staff to
follow them with complete failure.
What became clear to me was that they were useful for training or for new
conditions that people were not familiar with but for regular outpatients
use they were not practical.
So that is why in the ZEDAP (Zimbabwe Essential Drugs Action
Program) materials we tried to define for each complaint or condition the
three or four key questions that should be
asked and the three key signs (findings on examination) that should be
sought. We found that if we could get health workers to at least ask four
questions and elicit three signs they would be able to diagnose fairly
accurately and then either treat or refer. Remember "common conditions occur
commonly" The priority should be to ensure that fever patients are asked
about coughing, dysuria, headaches and rigors and that they have their
temperature actually measured, their neck checked for stiffness and their
respiratory rate counted or their chest listened to before they are given
chloroquin. These materials were produced by experienced district staff and
revised by health workers from all levels who also field tested the
materials. There are 9 clinical modules and 6 management ones. Two of the
modules do include flow charts but in general specific questions and signs
are suggested for all common complaints.
I would suggest that you evaluate these modules thoroughly before you decide
on the flow chart methods. Also what ever you decide to use I would
encourage you to evaluate the effectiveness of the materials in changing
practice not merely knowledge. A pre-post study with a control group would
be very easy to organize.
Good luck,
Richard Laing
Richard Laing (Associate Professor)
Department of International Health,
Boston University School of Public Health,
53 Bay State Rd, Boston 02215 MA USA
Tel 1-617-353-6630
Fax 1-617-353-6330
e-mail richardl@bu.edu
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