Sultanate of Oman - World Health Organization

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Sultanate of Oman - World Health Organization

Report Facilitators MeetingJoint WHO Meetings with Ministry of Health onthe WHO Integrated Management for Emergencyand Essential Surgical Care27-28 February, 2007Muscat, Sultanate of Oman1


Contents................................................................................................................................................Pages1. Executive Summary................................................................................................................32. Background .............................................................................................................................43. Objectives ...............................................................................................................................44. Third International Anaesthesia and Critical Care Conference ..............................................55. WHO meeting for facilitators .................................................................................................56. Discussions ............................................................................................................................57. Recommendations and Action Plan.......................................................................................68. Conclusions.............................................................................................................................69. Acknowledgements ................................................................................................................610. Annexes………………………………………………………………………………...........7Annex 1: Participants listAnnex 2: Programme AgendaAnnex 3: WHO training tools for improving skills of health personnel(Available at http://www.who.int/surgery/imeesc/en/index.html)2


3. Objectives• Joint WHO and MoH Facilitators Meeting on Integrated Management for Emergency & Essential Surgical(IMEESC) Care• Participate in the Third Oman International Anaesthesia and Critical Care Conference to:- Share the WHO Global Initiative for Emergency and Essential Surgical Care- Introduce the WHO IMEESC toolkit in the Technical session on education and training- To have informal side meetings during the two-day anaesthesia conference.4. Third International Anaesthesia and Critical Care ConferenceWHO/HQ/EHT/CPR and WHO/EMRO were requested by the WR Oman and MoH Oman, to participate in theThird International Anaesthesia and Critical Care Conference at Oman, which has approximately 400participants representing 150 countries.• WHO/ HQ and WHO/EMRO made the Key Note address on the Challenges of the GIEESC for theinaugural session of the Third International Anaesthesia and Critical Care Conference• The WHO IMEESC toolkit for training and distance learning was presented in the technical session of theThird International Anaesthesia and Critical Care Conference The WHO IMEESC toolkit was introduced, itsapplicability demonstrated in the day to day practice, training, and guidance on policy decisions at all levelsof healthcare aiming to reduce death and disability in trauma, pregnancy related complications andinfections (including HIV).5. Joint WHO with MoH Facilitators Meeting on IntegratedManagement for Emergency and Essential Surgical CareA Joint WHO and MoH, Facilitators Meeting was held on WHOIMEESC. The meeting participants represented key policy makersfrom MoH, health providers (surgeons and anaesthesiologists), andWHO/ country office/Regional Office/Headquarters.6. DiscussionsThe discussions were on the following issues:• At the tertiary and secondary care level there is access to emergency, surgical and anaesthesia care,which require standardization and quality assurance through better referral system and continuingprofessional development• There is often delayed access to life saving surgical and anaesthesia interventions at the primary andsecondary healthcare facilities• The issue of patient and health personnel safety in emergency, surgical and anaesthesia practices washighlighted• WHO generic guidelines can be adapted for patient consent, hand hygiene, operation room andemergency room settings, checklists prior to anaesthesia and surgery, equipment, planning for disasters,waste management towards patient safety• There is an interest to develop a guideline for Oman for trauma and emergency, but there is noconsensus among the specialists who have been trained by various trauma programs in USA, U.K andCuba.• There is a need for strengthening medical and nursing students training skills on emergency andessential surgical care towards reducing death and disability in trauma, pregnancy related complicationsand infection (including HIV).• The WHO IMEESC tool could meet the need for a standardized training.5


• Experience of introduction and implementation of the WHO IMEESC training project in 17 countrieswas shared.7. Recommendations and Action PlanThis meeting resulted in the following recommendations and action plan:• MoH to conduct a situation analysis for health care facilities on emergency and surgical care using thegeneric WHO Needs Assessment tool for resource limited healthcare facilities.• Policy decision on the adaptation of the WHO IMEESC tool kit for Oman.• A training workshop to be organized to demonstrate the use of the WHO generic tools for a standardizedtraining• Develop a task force on emergency and surgical and anaesthesia care. Taskforce to include health carepersonnel from multi-disciplines which are responsible for surgical and anaesthesia life savinginterventions.• Collaborate with WHO for training of trainers in Oman and for local adaptation of WHO IMEESC kitfor implementation• It was recommended that that all levels of health care facilities (including Primary Health Care) shouldbe involved in the IMEESC.8. ConclusionsThe meeting concluded with a consensus by MoH and WHO country office that EESC could be utilized towardsimproving the first referral level health facility’s services. It was recommended to establish a committee (Taskforce) on EESC, in order to develop strategies for rolling out the IMEESC package in line with the GIEESC, tointegrate the EESC to first referral Health Facility and to adapt the WHO IMEESC toolkit to Oman to strengthencapacities through a standardized training for the frontline health personnel performing life saving emergencyand surgical (including anaesthesia) interventions in Oman.9. Acknowledgment and collaborations for support- MoH Oman- WHO country office Oman, and WHO/EMRO- Departments of Essential Health Technologies, Evidence and Information for Policy (Patient Safety), Making PregnancySafer, Violence and Injury Prevention, Child and Adolescent Health, WHO6


Annex 1:Participants list in the meetingsDr Ali Jaffar, Advisor, (unable to attend)Department of Health AffairsMoH Directorate of primary health careSultanate of OmanDr Abdul W ZaroukSenior ConsultantDepartment of AneasthesiaRoyal HospitalMuscat, Sultanate of OmanDr Taha M Al-LawatiSr Specialist, Surgical OncologistDepartment of General SurgeryRoyal HospitalAl KhuwairSultanate of OmanDr Mohan Mathews,Sr Consultant, Anaesthesia,Royal HospitalAl KhuwairSultanate of OmanWHOMr Hassan Shawareb (unable to attend)WR Oman (acting)Dr Ruth M MabryTechnical OfficerWHO Country OfficeMuscat, Sultanate of OmanDr Nabila MetwaliRegional Adviser, Blood Safety, Laboratory &ImagingWHO/EMRODr Meena CherianProject: Emergency & Essential Surgical CareClinical Procedures Unit (CPR)Department of Essential Health TechnologiesWorld Health Organization, Geneva, Switzerlandtel:0041 22 791 4011;fax: 0041 22 791 4836cherianm@who.int;www.who.int/surgeryDr Ali Mastiani, Sr consultant,Neurosurgery, Khoula HospitalAl KhuwairSultanate of OmanDr Hamed Al Kindi,Senior Consultant and Head of Dept,Accident and Emergency,Department of AnesthesiaKhoula HospitalAl KhuwairSultanate of OmanDr Ashok SumantSenior Consultant and HeadDepartment of Aneasthesia and ICUKhoula HospitalMina Al FahalMuscat, Sultanate of OmanDr Irfan Farook,Adviser, Hospital Administration,Dept of Hospital AffairsSultanate of Oman7


Annex 2. Program Agenda- WHO Meeting and discussions with WHO Country Office and EMRO Regional Office- Joint WHO and Ministry of Health Facilitators meeting on IMEESC- Introduce and facilitate the use of the WHO IMEESC tool kit- Discussions on Collaborative approach to surgical training on emergency and essentialsurgical procedures and linked equipment- Recommendations and follow up action plan- Conclusions of meetings- Key Note address on the Challenges of the Global Initiative for Emergency and Essential Surgical Careat the inauguration of the Third Oman International Anaesthesia and Critical Care Conference.- Presentation of the WHO Integrated Management for Emergency and Essential Surgical care tools in thetechnical session of the Third Oman International Anaesthesia and Critical Care Conference.8


Annexe3: WHO training tools for improving skills of health personnelNeeds Assessment and Evaluation Form for RR esessoouu rcrce LLi ii mm iit itteedd HH eaal e ll tthh t CC aar ree FFaa cicii ll lii ittyytEssential Emergency Equipment in Emergency Room**At an entry point in any health facility such as:Emergency room/ Admission room / Treatment room/ Casualty room1. Name/Address of Health Care Facility ______________________________________Country ______________________________________2. Type of Health Care Facility (please check one) Primary or First referral level facility/ District Hospital/Rural Hospital Health Centre 3. Human Resources in emergency room (please indicate number of health staff) Doctors ___ Nurses ___ Clinical or Health officers ____Technicians ___ Paramedical staff ___4. Physical Resource(a) InfrastructureYesNo Is there an area or room designated for emergency care? Is there running water? If yes: Interrupted / Uninterrupted (please circle one) Is there an electricity source? If yes: Interrupted / Uninterrupted (please circle one)(b)EquipmentIs a list of essential emergency care equipment available?YesNo Is following available- Oxygen Cylinder: Interrupted /Uninterrupted (please circle one) - Oxygen Concentrator: Interrupted /Uninterrupted (please circle one) - Equipment for oxygen administration available (tubes, masks) Essential Emergency (EE) Equipment Yes, in some equipment Yes, in all equipment No Are the EE equipment in working order? Is there access to repair if equipment fails? Is there access to repair within the health care facility? Is there access to repair outside the health care facility? - If yes, how far (in km): 1-25 / 26-50 / 51-200 / >200 (please circle one) Is there an agreement for the maintenance of the equipment with the supplier? Do the health care staff in the emergency room get training in the use of theequipment? Is information available on supply, repair, and spare parts for the equipment? 5. Quality, safety, access and use Are the best practice protocols for management of essential emergencyprocedures available? Are the protocols for safe appropriate use of equipment in essentialemergency procedures available?Yes, in some procedures Yes, in all procedures No How often is ‘room to room inspection’ performed to ensure that EE equipment and supplies required for the essentialemergency procedures are available and functioning? (please circle one)Daily / weekly / monthly / 6-monthly / yearly / once in ___ years / never Are the information, education and training materials on emergency procedures and equipmentavailable in the emergency room for health care staff use? Are there introductions of any new procedures/interventions?- If yes, which procedure/intervention: (please specify) Has referral to other health facility decreased because of skills and knowledge of procedures andintervention? Are records maintained? 6. Policy Is there a policy to promote training for health care staff in the essential emergency management of trauma,obstetric care and anaesthesia? Is there a policy to update the protocols for the emergency management of trauma and obstetric care adapted tolocal needs? Are there any guidelines on donation, procurement, and maintenance of all EE equipment? Is there a list of extra health personnel to be contacted in disaster situations? For guidance use WHO generic list of Essential Emergency EquipmentDepartment of Essential Health TechnologiesWorld Health Organization, 20 Avenue Appia, 1211, Geneva 27,SwitzerlandFax: 41 22 791 4836 Internet: www.who.int/surgeryYesYesNoNo9


WHO Generic Essential Emergency Equipment ListChecklist describes minimum requirements for emergency and essential surgical care at the first referral health facilityCapital Outlays Quantity Date checkedResuscitator bag valve and mask (adult)Resuscitator bag valve and mask (paediatric)Oxygen source (cylinder or concentrator)Mask and Tubings to connect to oxygen supplyLight source to ensure visibility (lamp and flash light)StethoscopeSuction pump (manual or electric)Blood pressure measuring equipmentThermometerScalpel # 3 handle with #10,11,15 bladeScalpel # 4 handle with # 22 bladeScissors straight 12 cmScissors blunt 14 cmOropharyngeal airway (adult size)Oropharyngeal airway (paediatric size)Forcep Kocher no teeth 12-14 cmForcep, arteryKidney dish stainless steel appx. 26x14 cmTourniquetNeedle holderTowel clothWaste disposal container with plastic bagSterilizerNail brush, scrubbing surgeon'sVaginal speculumBucket, plasticDrum for compresses with lateral clipsExamination tableWash basinRenewable ItemsSuction catheter sizes 16 FGTongue depressor wooden disposableNasogastric tubes 10 to 16 FGBatteries for flash light (size C)Intravenous fluid infusion setIntravenous cannula # 18, 22, 24Scalp vein infusion set # 21, 25Syringes 2mlSyringes 10 mlDisposable needles # 25, 21, 19Sharps disposal containerCapped bottle, alcohol based solutionsSterile gauze dressingBandages sterileAdhesive TapeNeedles, cutting and round bodiedSuture synthetic absorbableSplints for arm, legUrinary catheter Foleys disposable #12, 14, 18 with bagAbsorbent cotton woolSheeting, plastic PVC clear 90 x 180 cmGloves (sterile) sizes 6 to 8Gloves (examination) sizes small, medium, largeFace masksEye protectionApron, utility plastic reusableSoapInventory list of equipment and suppliesBest practice guidelines for emergency careSupplementary equipment for use by skilled health professionalsLaryngoscope handleLaryngoscope Macintosh blades (adult)Laryngoscope Macintosh blades (paediatric)IV infusor bagMagills Forceps (adult)Magills Forceps (paediatric)Stylet for IntubationSpare bulbs and batteries for laryngoscopeEndotrachael tubes cuffed (# 5.5 to 9)Endotrachael tubes uncuffed (# 3.0 to 5.0)Chest tubes insertion equipmentCricothyroidectomy10


This list was compiled from the following WHO resources:WHO training manual: Surgical Care at the District HospitalWHO Emergency Relief Items, Compendium of Basic Specifications*WHO/UNFPA Essential drugs and other commodities for reproductive health services.WHO Essential Trauma Care Guidelines* For specifications refer to this bookDepartment of Essential Health TechnologiesWorld Health Organization, 20 Avenue Appia, 1211, Geneva 27,SwitzerlandInternet: www.who.int/surgery11

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