Enhancing Medical Certification of Cause of Death: Action Plan and Training Workshop
Join us at the MCCD Action Plan Training Workshop to improve training in medical certification of cause of death. Explore initiatives over the next 6 months and long-term strategies to enhance quality, accuracy, and compliance in death certification processes.
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Presentation Transcript
Session 2: MCCD Action Plan Training Workshop on Medical certification of cause of death
Action Planning Workshop to improve training in medical certification (High Level Outcomes) Palau Royal Hotel, 5 - 7 March 2024
Next 6 months (to September 2024) 1. Conduct quality review for morbidity and mortality Need assistance to conduct quality review. Checking pre-workshop and post-workshop completion and accuracy of MCCD, where are there still gaps? Strengthen monitoring processes assurance: Review committees to monitor quality. 2. Internal process for quality assurance check (Quarterly reviews): Develop case reviews of MCCD completed for the next 6 month. Medical record to provide report of cases. Utilize existing Clinical meetings (Thursdays) process in place. Present cases quarterly basis. 3. ICD training for medical doctors More understanding of ICD-10 codes for doctors even though not responsible for coding. May reduce R99 codes. EHR (got November 2022) gives codes for diagnoses so have some familiarity. Enhance understanding on the importance of vital statistics data generated
Next 6 months (to September 2024) 4. MCCD training with doctors (28 doctors total in Palau). Have doctors meeting every Thursday to do refreshers - continue with monthly mortality reviews (about 10 deaths/month). Using case scenarios to discuss. Joint training with medical records. For new hires, online training on MCCD (maybe WHO, Vital Strategies). 5. Develop SOPs Procedural and System Alignment SOPs that will clarify that doctor who pronounces fills out the death certificate, but also attending or doctor who knows person should be consulted for more case history. Strengthen monitoring. 6. Improvement of information input entered on Tamanu or HIS. Assess and resolve triple entry burden manual, then enter both Tamanu and HIS. Transition process into 1 system 2 separate unique identifiers e.g. Interoperability of health systems, same information for the same person. Improve documentations on Tamanu, HIS and Discharge e.g. Interval time not available on Tamanu Form for MCCD.
Next 6 months (to September 2024) 7. Develop some kind of disclaimer or statement: The official death certificate is the paper version. Do not refer to Tamanu for death certification. Concern is that Tamanu is not complete (not all ICD-10 codes are available) and is not intended for mortality. Doctors do not want to have their names associated with discrepancies between the two. 8. Access to experts Ability to consult with experts; posting difficult cases to a death certification forum.
Long term 1. Revision of death certificate to international standards . May require additional training for manner of death, etc. 2. Develop SOPs around death certification and coding (also SOPs around morbidity); include what happens after certification and coding (statistics, courts, etc.); SOPs on process, for example death certificate must be done within 10 working days. 3. Executive decision on unified system for Palau Addressing three different systems concerned with morbidity and mortality (HIS, Tamanu (EHR), and the paper death certificate). Have been asked to record mortality in Tamanu, but it does not have time interval and ICD-10 is not fully available, so doesn t match paper record. The paper certificate is official record which is passed on to the courts. Tamanu company (Beyond Essential Services) is only loading codes that are most used or on case-by-case request; do not have sufficient technical support to load all codes. Morbidity and mortality have to be kept separate. Fix Tamanu for morbidity. Look into IRIS for mortality; get peer-to-peer training from Fiji, for example, rather than IRIS training (expensive). Could then link IRIS to Tamanu. 4. Train of Trainers (TOT) for Palau
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