Joshi Meena, Sahoo Tanushree, Thukral Anu, Joshi Poonam, Sethi Amanpreet, Agarwal Ramesh
College of Nursing, All India Institute of Medical Sciences, New Delhi, India.
Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Indian Pediatr. 2018 Sep 15;55(9):744-747.
To increase the duration of Kangaroo mother care (KMC) in preterm infants from an average of 3 hours/day to at least 6 hours/day over 7 weeks through a Quality improvement (QI) approach in a tertiary-care neonatal unit.
Preterm mother-infant dyads who were admitted in the Neonatal intensive care unit and KMC ward were enrolled in this study. A QI team comprising of nurses, nurse educators, resident physicians and nursing-in-charge of unit was formed. The potential barriers for prolonged KMC were evaluated using fish bone analysis. A variety of measures (allowing family members including male members during night for doing KMC, making KMC an integral part of treatment order, introducing the concept of weekly KMC champions, etc.) were introduced and subsequently tested by multiple Plan-do-study-act (PDSA) cycles. Data on duration of KMC per day was measured by bedside nurses on daily basis.
20 eligible mother-infant dyads were studied during implementation period (50 d). The mean (SD) weight and gestation of infants were 1199 (356) g and 31.1 ( 2.3) wks, respectively. We achieved our goal by step-wise implementation of changes through construction of 3 PDSA cycles. The duration of KMC increased to 6 hours-a-day over a period of 7 weeks. Evaluation at 6 and 12 months in the post-implementation phase suggested sustenance of improved KMC duration up to 9 h/day in the unit.
Ongoing quality improvement measures increased the duration of KMC from a baseline of 3 h to 6 h in eligible preterm infants, and the results were sustained at 6-12 month.
通过三级护理新生儿病房的质量改进（QI）方法，在7周内将早产儿袋鼠式护理（KMC）的时长从平均每天3小时增加至至少6小时。
纳入入住新生儿重症监护病房和KMC病房的早产母婴对。组建了由护士、护士教育工作者、住院医师和科室护士长组成的QI团队。使用鱼骨图分析法评估延长KMC的潜在障碍。引入了多种措施（允许包括男性成员在内的家庭成员在夜间进行KMC、将KMC纳入治疗医嘱的一部分、引入每周KMC冠军的概念等），随后通过多个计划-实施-研究-改进（PDSA）循环进行测试。每日由床边护士测量KMC的每日时长数据。
在实施期（50天）内研究了20对符合条件的母婴对。婴儿的平均（标准差）体重和孕周分别为1199（356）克和31.1（2.3）周。通过构建3个PDSA循环逐步实施变革，我们实现了目标。KMC时长在7周内增加到了每天6小时。实施后阶段6个月和12个月的评估表明，该科室KMC时长改善至每天9小时的效果得以维持。
持续的质量改进措施使符合条件的早产儿的KMC时长从基线的3小时增加到了6小时，且结果在6至12个月时得以维持。
