GPH is a 100 bed hospital in Accra set up primarily to provide healthcare for police officers and their families in 1976. It also serves the local populace, expatriates, and person who is in contact with police who requires medical attention e.g. RTAs, crime suspects. The hospital has a core medical staffing strength of 175 personnel (medical consultants, medical specialist, general practitioners, dentists, specialist pharmacists and pharmacists, nurses, midwives) and 102 allied health and administrative staff. Majority of patients seen (about 85%) are not police staff/families. There are similarities between the police and military hospitals in Ghana, as most staff are trained police officers and wear police uniform. Nurses can wear police or nurse’s uniform. GPH has many doctors and pharmacists plus physician assistants and pharmacy technicians. The hospital also trains many nursing and pharmacy interns, students on clinical attachment. Nurses do not routinely prescribe medicines but can do so if required.
In Paediatrics branded products are preferred as deemed to be ‘more effective’ than generics which may be of dubious quality. No computerised records or prescribing. The hospital has a Main Pharmacy which provides non out-of -pocket services to entitled patients i.e. police personnel and family members, national health insurance holders, RTA victims. It also has a Chemist on-site which provides medicines at close to cost price on cash and carry basis, and is open 24 hours a day 7 days a week to augment the main pharmacy services.
We were welcomed by Daniel, Director of Pharmacy, and taken to meet with the Hospital Management Committee. Formal meeting in Boardroom with detailed introductions to roles and information about GPH. The Medical Director is the Lead Officer and she is a Consultant Paediatrician. Other key staff present were Directors of Nursing Services, Audit, Finance, Administration, and Clinical Education Lead. Administrative meetings held each Monday and Clinical Education meetings each Wednesday. A large proportion of staff are trained Police Officers and wear full uniform at work. Key aspect of GPH is discipline and ‘chain of command’. No regular in-service education programme for all staff but there are weekly management and clinical meetings. CPD is mandatory for medical staff, pharmacists and nurses, and staff mostly access CPD opportunities via external training.
The main focus of DTC meetings is selection of required drugs and medical consumables, procurement, analysing tender results to ensure efficacious and reliable drugs/consumables are procured, consider new medicines and can meet on an ad-hoc basis to deal with complaints. Any issues identified by DTC are brought to Management Team and may be addressed by a Clinical Education session. They also use ‘Signal letters’ approved by Medical Director which are memos requesting action. These are actioned via heads of department and cascaded to all staff – chain of command approach means that implementation is successful as staff must follow orders.
The PPS went well. Some difficulties in accessing notes due to ward rounds. No national guideline for some common infections e.g. sepsis, wound infection, so it was difficult to assess compliance with guidelines for some patients. Overall prevalence of antibiotic use was 57.1% in adult wards, 70 % in the children’s ward and 100 % in the neonatal ward.