Neonatology, Government Medical College and Hospital Aurangabad, Aurangabad, Maharashtra, India.
Pediatrics, Government Medical College and Hospital Aurangabad, Aurangabad, Maharashtra, India.
BMJ Open Qual. 2022 May;11(Suppl 1). doi: 10.1136/bmjoq-2021-001459.
Kangaroo Mother Care (KMC) is a low-resource, evidence-based, high-impact intervention for low-birth weight (LBW) care. Quality improvement in KMC requires meso-level, macro-level and micro-level interventions. Our institution, a public teaching hospital, hosts a level-II/III neonatal intensive care unit (NICU). The average demand for beds typically exceeds available capacity, with 60% occupancy attributed to LBW patients. There was low uptake of KMC practice at our unit.
In the initial phase, we aimed to improve the coverage of KMC in admitted eligible neonates from a baseline of 20%-80% within 15 days. After a period of complacency, we revised the aim statement with a target of improving the percentage of babies receiving 6-hour KMC from 30% to 80% in 12 weeks.
We report this quasi-experimental time-series study. With the Point of Care Quality Improvement methodology, we performed Plan-Do-Study-Act (PDSA) cycles to improve KMC practice. We involved all the healthcare workers, mothers and caregivers to customise various KMC tools (KMC book format, KMC bag, mother's gown) and minimise interruptions. Feedback from all levels guided our PDSA cycles.
The percentage of babies receiving at least 1-hour KMC increased from 20% to 100% within 15 days of August 2017. In the improvement phase, baseline 6-hour KMC coverage of 30% increased to 80% within 12 weeks (October-December 2017). It sustained for more than 2 years (January 2018 till February-2020) at 76.5%±2.49%.
Quality improvement methods helped increase the coverage and percentage of babies receiving 6-hour KMC per day in our NICU. The duration specified KMC coverage should be adopted as the quality indicator of KMC. The training of healthcare workers and KMC provider should include hands-on sessions involving the mother and the baby. Maintaining data and providing suitable KMC tools are necessary elements for improving KMC. Minimising interruption is possible with family support and appropriate scheduling of activities. Having a designated KMC block helps in peer motivation.
袋鼠式护理（KMC）是一种低资源、基于证据、对低出生体重（LBW）护理有重大影响的干预措施。KMC 的质量改进需要中观、宏观和微观层面的干预措施。我们的机构是一家公立教学医院，拥有二级/三级新生儿重症监护病房（NICU）。通常，床位需求超过可用容量，60%的入住患者为 LBW 患者。我们科室的 KMC 实践采用率较低。
在初始阶段，我们的目标是在 15 天内将符合条件的入院新生儿接受 KMC 的比例从 20%提高到 80%。在一段时间的自满之后，我们修订了目标陈述，将目标定为在 12 周内将接受 6 小时 KMC 的婴儿比例从 30%提高到 80%。
我们报告了这项准实验性时间序列研究。使用即时护理质量改进方法，我们通过计划-执行-研究-行动（PDSA）循环来改进 KMC 实践。我们让所有医护人员、母亲和照顾者参与进来，定制各种 KMC 工具（KMC 书籍格式、KMC 包、母亲长袍）并减少干扰。来自各个层面的反馈指导了我们的 PDSA 循环。
2017 年 8 月的 15 天内，接受至少 1 小时 KMC 的婴儿比例从 20%增加到 100%。在改进阶段，基线 6 小时 KMC 覆盖率从 30%增加到 12 周（2017 年 10 月至 12 月）的 80%。此后，该比例在 2 年多的时间里（2018 年 1 月至 2020 年 2 月）一直维持在 76.5%±2.49%。
质量改进方法有助于提高我们 NICU 中接受每天 6 小时 KMC 的婴儿比例和覆盖率。指定 KMC 覆盖时间应作为 KMC 的质量指标。医护人员和 KMC 提供者的培训应包括涉及母亲和婴儿的实际操作环节。保持数据和提供适当的 KMC 工具是改进 KMC 的必要要素。通过家庭支持和适当安排活动，可以尽量减少干扰。指定 KMC 时间有助于促进同行之间的相互激励。
