Pediatrics, Ovum Hospitals, Bangalore, India.
Pediatrics, Ovum Hospitals, Bangalore, India
BMJ Open Qual. 2022 May;11(Suppl 1). doi: 10.1136/bmjoq-2021-001771.
Kangaroo mother care (KMC) is a proven intervention for improving intact survival in low birthweight babies. Despite the evidence, its adoption and implementation have been low. Availability of mothers for the first few days of life is a specific challenge at outborn units. We used a quality improvement (QI) approach to implement and sustain KMC in stable low birthweight babies (<2000 g) from a baseline of 2.7 hours/baby/day to 6 hours/baby/day (prolonged KMC) over a period of 2 years in our unit through a series of Plan-Do-Study-Act (PDSA) cycles.
All babies with birth weight <2000 g not on any respiratory support or jaundice were eligible. The key quantitative outcome was KMC hours/baby/day. A QI team consisting of nurses, nursing in charge and consultants of the unit was formed. The potential barriers for prolonged KMC were evaluated using fishbone analysis. A variety of parent-centric measures (provision of bed to mothers apart from KMC chairs, foster KMC, structured KMC counselling through a video, making KMC an integral part of treatment order) were introduced and subsequently tested by multiple PDSA cycles. Data on the duration of KMC per day were measured by bedside nurses on a daily basis.
A total of 134 mother-baby dyads were enrolled over 2 years. The mean gestation (SD) and mean birth weight (SD) were 33 (2) weeks and 1557 (295) g, respectively. 78 (58%) babies were outborns. We implemented prolonged KMC over 9 months and sustained it over the next 18 months. KMC duration increased from a median of 2.7 hours/baby/day from baseline to a median of 7.4 hours/baby/day after implementation.
Prolonged KMC could be implemented and sustained over 2 years by implementing parent-centric best practices even in a predominant outborn unit.
袋鼠式护理（KMC）是一种经过验证的干预措施，可提高低出生体重儿的完整存活率。尽管有证据表明，其采用和实施情况不佳。在外出单位，母亲在生命的头几天的可用性是一个特殊的挑战。我们使用质量改进（QI）方法，通过一系列计划-执行-研究-行动（PDSA）循环，在 2 年内将我们单位的稳定低出生体重儿（<2000 克）的 KMC 从基线的 2.7 小时/婴儿/天延长至 6 小时/婴儿/天（延长 KMC）。
所有出生体重<2000 克且未接受任何呼吸支持或黄疸治疗的婴儿均符合条件。关键的定量结果是 KMC 小时/婴儿/天。成立了一个由护士、护士长和单位顾问组成的 QI 团队。使用鱼骨图分析评估了延长 KMC 的潜在障碍。引入了各种以父母为中心的措施（为母亲提供与 KMC 椅子分开的床、寄养 KMC、通过视频进行结构化 KMC 咨询、将 KMC 作为治疗医嘱的一个组成部分），并通过多次 PDSA 循环进行了测试。床边护士每天测量 KMC 每天的持续时间。
在 2 年内共纳入 134 对母婴。平均胎龄（SD）和平均出生体重（SD）分别为 33（2）周和 1557（295）克。78（58%）例婴儿为外出。我们在 9 个月内实施了延长 KMC，并在接下来的 18 个月内维持了 KMC。KMC 持续时间从基线时的中位数 2.7 小时/婴儿/天增加到实施后的中位数 7.4 小时/婴儿/天。
即使在主要外出单位，通过实施以父母为中心的最佳实践，也可以在 2 年内实施和维持延长的 KMC。
