Department of Neonatology, Government Chengalpattu Medical College, Chengalpattu, Tamil Nadu, India.
Department of Neonatology, Government Chengalpattu Medical College, Chengalpattu, Tamil Nadu, India
BMJ Open Qual. 2022 May;11(Suppl 1). doi: 10.1136/bmjoq-2021-001775.
India has the highest number of preterm births and maximum number of deaths due to prematurity. Chengalpattu Government Medical College had 11 593 deliveries annually in 2020, of which 2252 of neonates were low birth weight. 2016 Cochrane review concluded that Kangaroo Mother Care (KMC) reduces the morbidity and mortality in low birthweight infants. The average duration of KMC in our unit was around 4.6 hours/baby/day.
To improve the duration of KMC in stable low birthweight babies from short duration to continuous duration (>12 hours) over 8 weeks.
The implementation phase was conducted during January 2021 and February 2021. All babies with birth weight <2 kg and who were haemodynamically stable were enrolled. QI (Qualitympovement) team included staff nurses, nursing in charge, resident doctors and consultants. Potential barriers were listed using fishbone analysis. Various possible interventions were identified and a priority matrix was formed to decide the sequence of introduction of changes. The following measures were subsequently tested by multiple PDSA (Plan Do Study Act) cycles: ensuring the availability of KMC charts, combining KMC chart with individualised weight chart, documentation of KMC duration in case sheets, increasing number of KMC chairs, opening of mother-neonatal ICU (M-NICU), KMC slings for mothers, education videos in local language and rewards for mothers.
Duration of KMC, recorded by bedside nurses on daily basis.
A total of 86 newborns were enrolled. At the end of 8 weeks, average duration of KMC increased to 16.6 hours/baby/day. The intervention which was most useful in increasing KMC duration was opening of M-NICU. We were able to sustain the improvement at the end of 6 months.
Sequential measures taken as a part of QI initiative, helped to increase the average duration of KMC from 4.6 hours/day to 16.6 hours/day, without much additional resources.
印度早产儿数量最多，早产儿死亡人数也最多。Chengalpattu 政府医学院 2020 年每年有 11593 次分娩，其中 2252 名新生儿为低出生体重儿。2016 年 Cochrane 综述得出结论，袋鼠式护理（KMC）可降低低出生体重儿的发病率和死亡率。我们科室的 KMC 平均持续时间约为每天 4.6 小时/婴儿。
将稳定的低出生体重儿的 KMC 持续时间从短时间（<12 小时）延长至 8 周内的连续时间（>12 小时）。
实施阶段于 2021 年 1 月至 2 月进行。所有出生体重<2kg 且血流动力学稳定的婴儿均被纳入研究。质量改进（QI）团队由护士、护士长、住院医师和顾问组成。使用鱼骨图分析列出了潜在的障碍。确定了各种可能的干预措施，并形成了优先矩阵，以决定引入变更的顺序。随后通过多个 PDCA（计划-执行-检查-行动）循环测试了以下措施：确保 KMC 图表的可用性、将 KMC 图表与个体化体重图表相结合、在病历中记录 KMC 持续时间、增加 KMC 椅子数量、开设母婴 ICU（M-NICU）、KMC 吊带供母亲使用、用当地语言制作教育视频以及为母亲提供奖励。
由床边护士每天记录的 KMC 持续时间。
共纳入 86 名新生儿。8 周结束时，KMC 的平均持续时间增加到每天 16.6 小时/婴儿。在增加 KMC 持续时间方面最有用的干预措施是开设 M-NICU。我们能够在 6 个月结束时维持这一改进。
作为质量改进计划的一部分采取的连续措施有助于将 KMC 的平均持续时间从每天 4.6 小时增加到每天 16.6 小时，而无需额外增加资源。
