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Health Screening: Planning & Implementation

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The following is intended to help in planning health fairs as part of the Agape/Community Care clinical. Material is divided into several functional sections. In each section there are pointers for planning and implementation. Last update 9/2006

It is essential that planning and taking care of details begin as soon as possible. Problems often arise at the last minute, and if details are left until then the situation quickly deteriorates.

The basic health problems/diseases to be screened are hypertension, diabetes, asthma, body mass index, and breast cancer. More may be added if resources and people are available. Examples of additional areas include poison control, accident prevention, Hispanic Nurses Association, Agape volunteer recruitment, CHIP/Medicaid assistance (via Concilio), and others. Photo: Screening event

Current resources (these are being updated) include UTSW Mobile Mammogram Screening Program, YWCA Mobile Mammograms, EDHC community liaison, Agape director, Agape lay health promoter, Dallas Independent School District (including PTAs and school nurses), American Heart Association, American Diabetes Association, other national organizations, and (for favors) cosmetics managers at large department stores. Also, see above. In every case, contact must be made as soon as possible. Find new resources - be creative!

Possible new or undeveloped resources or tactics include holding a screening event at one of the schools with whom we work (in conjunction with PTA meeting or school event), Saturday screening, partnering with other churches, developing additional resources for screening, and others.

The roles to be filled are listed below. Volunteers are needed. Some will be able to commit only to 2-3 hour blocks, which is just fine (greatest need for volunteers is in the morning).

Manager: Does planning & coordination. Important to involve others. Critical tasks include:

• Ensure that each major area stays on track & on schedule (see schedule below)
• Maintain contact with key outside resources such as mammogram team, East Dallas Health Center, and church.
• Schedule all areas of church needed (see the pastor and the church secretary; Open Door Learning Center director). Agape staff should notify the church as soon as possible when event is originally scheduled and students should follow-up when date approaches.
• Maintain contact with CK
• During the event, the manager keeps the event moving and solves problems. Stays in touch with mammogram staff and others.
• Maintains list of volunteers and participating agencies (name, address, phone, etc.) so we can send thank you letters after the event.
• Stays calm!

Volunteer Recruitment & Personnel: Ensures that the following are in place. Important to begin working on this as soon as possible.

• Greeter(s) to meet people at the door and direct to screening or clinic, answer questions, solve individual problems.
• Sign-in
• Translator(s) - we have never had too many, so push this as far as possible. Spanish-speaking BU students should be recruited.
• Person or persons to be in charge of each aspect of screening, e.g., one person for HTN, one for DM, and so on.
• Tracker makes sure that data sheets are collected when patients are finished.
• If there are too many volunteers, explore with faculty what we might do with them.

Non-health resources needed include the below. See specific areas for health-related supplies and equipment

• Fliers
• Table signs
• Tablecloths
• Banner
• BMI charts
• Data sheets
• Balloons
• Copier and extension cord
• Translators & Volunteers as described above

Preparation

Immediate steps

• Plan with mammogram team a date and time for the van to be stationed at the church parking lot.
• Contact pastor of Grace United Methodist to ask permission to use the library and/or other areas for the health fair. Be sure no conflict with other meetings or events.
• Encourage women over 40 to set up appointments for mammograms with the lead promotora. Everyone in the clinic should participate in this. Make a brief flyer for clinic staff outlining parameters (> 40 years, no Hx breast cancer, no breast mass). This is ongoing until mammogram slots are filled.
• Assign students and or volunteers to specific areas of screening (HTN, asthma, etc.).
• Go through available materials to see what new is needed. Think in terms of areas to be screened and roles. Gather display posters and health pamphlets regarding diseases to be screened.
• It is essential that any specific requirements of the mammogram screening unit be met, e.g., in fall 2006, several women were not screened because of documentation issues (proof of residency).
• Obtain folders for health teaching materials to give to each patient.
• Make flyers in English and Spanish. These will be printed 2 sided. We have these ready to go. Check with the instructor.
• Begin distributing flyers. We advertised with flyers in the elementary school, the church where it will be held, the church nursery, and during home visits to make the community aware of the health fair. For a large fair, distribute at stores, other churches, other elementary schools, senior centers, and so on. Distribution of flyers is ongoing.
• Begin volunteer recruitment. Baylor students are sometimes a good source. Work with CHN and patient education faculty. Announce at Lunchencounter. This is a good learning opportunity for J1s and J2s - as well as an opportunity for seniors to experience another clinical setting.

Four Weeks Before Event

• Inventory equipment and supplies needed. Looking at how frequently we use particular supplies, are we likely to need to order anything additional supplies? See below for a list of what is needed according to area.
• Gather favors (i.e. perfume samples, cosmetics, toothbrushes, breast cancer buttons, etc.) to give to the women & sacks to put the favors in. This should be an organized effort. Seek assistance from students, parents, spouses, etc. who are knowledgeable about retail sales. Start early on this!
• Continue volunteer and student recruitment as described above.
• Begin preparing folders with important information regarding health problems and the church and clinic services. Folders should have critical selected information as opposed to everything we can stuff into the pockets.
• Map out the event - walk through each station to check flow.

By two weeks before the event, all tasks and equipment should be in place

• Check all equipment to be sure working properly and that there are enough supplies (glucometer strips, blood pressure cuffs, scales, alcohol swabs, stethoscopes, lancets and disposal container, peak flow meters, mouthpieces, gloves, etc.). Persons in charge of the screening areas will accomplish. Manager is responsible.
• Folders, handouts, questionnaires, other administrative supplies are staged
• Gather decorating supplies (i.e. tablecloths, streamers)
• Confirm volunteers
• Confirm other agencies
• Confirm with church

One week before the event

• Confirm with women who have appointments for mammograms that they will attend.
• Review all previous steps to be sure everything is in place.
• Establish a procedure for handing off data sheets from (1) station to station, (2) at end of screening cycle, and (3) for patients who need medical attention during the event. For number 3, make a copy of the data sheet to go with the patient's chart.

The day before the event

• Remind church and learning center that the event is scheduled and that the mammogram van will need to park next to church where school vans/bus usually park. Thank them for understanding and helping.
• Set up the library with the separate stations for each screening and tables with displays and pamphlets on the diseases.
• Desk for sign-in set up & stocked with plenty of pens and paper
• Lay out favor bags and folders
• Re-check supplies and function of glucometers
• Call volunteers and remind them of what time to arrive to the health fair

The morning of the event

• Arrive 15 minutes prior to unlock door and do any last minute preparation
• Stay calm

The week after the event

• Compile data on number screened, outcomes, anyone started on treatment, follow-ups needed.
• Set up phone or home visit follow-ups (with assist from CK).
• Write thank-you notes to everyone involved.
• Identify problems, new resources, new ideas and give to CK for inclusion in website.

Basic order of operations is as follows (change according to need/situation):

1. Client sign-in (name, address, phone number, and date of birth)
2. History-taking (ask clients questions from questionnaires) and blood pressures (BP are taken early to prevent elevations r/t anxiety)
3. Weight and height/calculate BMI/diet and exercise teaching
4. DFS if needed
5. Asthma
6. BSE teaching
7. Collect data sheet & give favors
8. Mammograms in the van

*If client has high blood pressure, high blood glucose, or other urgent health problem, instruct them to complete the screenings and have an escort take them to the Agape clinic with a copy of the data sheet for the chart. This has been an area of confusion in the past and it is important that everyone involved understand the procedure.

It is important that there be a walk-through prior to the event and that everyone in the Agape group participate. The walk-through should include patient(s) needing sick care.

Screening Areas

Overview: there should be one file folder or box for each station/job and these should contain (in sheet protectors):

• Checklist for that area
• Originals of handouts
• Instructions for station volunteers
• Extra handouts

It is important that each clinical group leave behind updated folders and materials.

Hypertension (alta presion) and healthy heart teaching need

• Three regular BP cuffs, 1 large BP cuff, 1 medium/small BP cuff or Dinamaps (Check out LRC and ensure correct accuracy and correct functioning)
• Handouts/poster on hypertension and healthy heart (Spanish & English)
• Be aware of current guidelines on hypertension, e.g., different parameters for hypertension with and without common risk factors, e.g., <130/80 with DM.

Height, weight and heart risks (la altura, el peso, y reisgo del Corazon) need

• One to two scales (get from clinic and check accuracy and correct functioning before event
• BMI ranges chart
• Handouts/posters on exercise, diet (foods high/low in sodium and fat), losing weight safely, and related. Recipe cards or booklets should be provided

Diabetes (la diabetes) need

• Two glucometers (get from clinic, ensure accuracy and correct functioning two weeks before event)
• Lancets, alcohol, band aids, gloves (get from clinic)
• Call American Diabetes Association for pamphlets
• Call Dallas Concilio to see if they can come do screenings and teaching
• OJ or candy for those who are hypoglycemic
• Handouts/poster on diabetes management (diet, foot care)

Immunizations (las inmunizaciones) need - We usually do not offer immunizations as this results in a marked increase in complexity

• Trained screeners and "shooters"
• Vaccines, syringes, needle, alcohol, gauze, band aids, gloves (supplies from the clinic and Betty Lou)
• Call Betty Lou Gary
• Acetaminophen or ibuprofen to give before injection
• Toy box for children
• Stickers
• Handouts

Asthma (el asma) need - We have had little return on asthma screening and for most events will not screen for asthma

• Two peak flow meters (get from clinic and ensure accuracy and correct functioning before event)
• Pediatric & adult mouthpieces (get from clinic)
• Pulmonary function machine (get from clinic)
• Instructions for screeners on how to do screening.
• Charts with normal ranges (kids, adults, male, female)
• Call Children’s Medical Center (Debra Jiminez 214-546-1434 or 214-648-5418) to see if a Spanish speaking asthma specialist can come
• Bubbles for prizes
• Handouts/poster on asthma prevention and management

Mammogram and BSE (examiner los pechos) need

• Teaching on how and when to do BSE using breast models (need breast models)
• Handouts/poster on BSE
• Breast models from skills lab
• Cancer information

Depression (an important screening area - significant numbers of positives in fall 2004)

• For screening use the Spanish/English teaching tool found here - Spanish and here - English

The clinic

The clinic will operate as on other days, except that there will be two students from the Agape clinical group to concentrate on the clinic and assist volunteers in working in the clinic. We would like for as many volunteers as possible to rotate through the clinic so that they can see how Agape operates.

Other

A children's area with play and related materials, especially crayons and the like is needed for most events. With some lead time and sufficient resources this can be used as a developmental screening area and opportunity to teach parents about developmental enhancement.

Authors

• Sereniti Young, RN, Johns Hopkins Medical Center
• Cara Kerr, student, Baylor School of Nursing
• Kristin Wong, student, Baylor
• Tara Thompson, student, Baylor