guidelines for the integrated management of severe acute malnutrition

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ACF-In Guidelines for the integrated management of SAM Monitoring and evaluation 124 elsewhere and the service to which the patient is referred will “take over” the future care of the child from the malnutrition team. “Wrong Admission”: This is recorded where it is found that a patient who does not fulfil the criteria for SAM has been inadvertently admitted to the in-patient programme and given a SAM number. This patient should be treated for any other illness for which the patient has been admitted and then discharged. All the SAM records should be marked “wrong admission” and the reason for revision of the diagnosis of SAM entered in the multi-chart; the multi-chart is filed with the other multi-charts and not discarded. The SAM number is NOT assigned to another patient. The monthly report must indicate the number of wrong admissions to the IPF. 3. Tools OTP tools � OTP chart is a single A4 double sided sheet upon which all the OTP information is recorded (see annex 8). � The OTP Registration book (see annex 07) contains simple basic information to assist management, organisation, control, reporting and evaluation of the OTP site and to ensure that patients are not “lost” if their record is misplaced, misfiled or otherwise readily found when required. � The OTP monthly report (see annex 14). The following information is collected in the registration book: Identification • SAM No • Child Name and mother/ father/ caretaker name if it facilitates the child identification and follow up • Age • Sex • Address: The address needs to be sufficiently detailed for the outreach worker (or other home-visitor) to find the actual house. If there is no address then there should be directions and a description of the house. • Phone N° where this is available. Type of admission, and transfer record. • Date of admission • New admissions: Wasted, Oedematous, Relapse. • Transfer-in from In-patient care, Return from In-patient care, Transfer-in from another OTP, Re-admission of defaulter (
ACF-In Guidelines for the integrated management of SAM Monitoring and evaluation 125 • Height • WFH Z-score • Oedema Outcome • Date of discharge • Type of discharge: cured (discharge to the SFP is not considered as a transfer); unknown; defaulter; died; transfer-out to In Patient Care; transfer-out to another OTP and non-responserefused-transfer. • Name of in-patient facility used for transfer-out. In-Patient Tools � In-patient Multi-chart is an A3 folded double sided chart that contains all the information necessary to manage an in-patient with SAM 198 � Registration book: there should be a special registration book for the SAM children. The inpatient register contains the same information as the OTP register with the exception that an additional column is introduced with the name of the referring OTP site listed. The benefits are the same as with the OTP registration book. The usual ward simple register is not sufficient. � The in-patient facility monthly report. In patient multi-chart is the primary tool for managing in-patients (see annexes 9 and 10) It should be filled for each patient. It is the primary tool for managing malnutrition and is recommended for all facilities looking after these patients. Other documents and local hospital records should not be used for these patients; there is no place for spending time making duplicate records. The chart is designed so that it: 1. allows proper control of all aspects of the care of the patient (from admission to follow-up and throughout his/her stay in the in-patient facility); 2. Gives detailed information for each individual case’s progression (changes in health and nutritional status, treatment phase and diet, medical treatments, clinical signs, temperature, etc.). 3. Follows the daily weight of the child which is plotted on a graph. 4. All the staff use the same chart. They all have ready access to the information collected by other grades of staff and it can be integrated together to give the doctor/nurse an immediate and accurate indication or the state of progress of the child. All the essential information is recorded systematically in the same predetermined part of the chart. The information can thus be found easily and quickly for each patient. 5. The language used in the chart should be the local language understood by all the staff (assistants) and not an international language only understood by the medical staff. 6. Inspection of the Charts allows the clinician in charge to quickly see if a patient needs special attention and allows all supervisors to control the quality of work of their staff. 198 In many hospitals the administration insists upon using its own style of patient record (docket) – the same type of record being used for all patients within the hospital. This is particularly the case when administrators use the information recorded to charge the patient for their care. Most hospital style records are inappropriate for the type of information necessary to successfully manage moderate numbers of SAM children. Experience has shown that changing from the normal ward record keeping to the simple SAM in-patient chart (and having staff trained in its use), can lower the mortality by up to 50%.
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Cover photography: © ACF, Anne-Dom
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guidelines for the integrated management of severe acute malnutrition

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