Pediatrics, SNR Hospital, Kolar, Karnataka, India.
Pediatrics, Sarji Hospital, Shimoga, Karnataka, India.
BMJ Open Qual. 2023 Oct;12(Suppl 3). doi: 10.1136/bmjoq-2023-002307.
Kangaroo mother care (KMC) is a proven intervention for intact survival in preterms. Despite evidence, its adoption has been low. We used a point of care quality improvement (QI) approach to implement and sustain KMC in stable low birthweight babies from a baseline of 1.5 hours/baby/day to above 4 hours/baby/day through a series of plan-do-study-act (PDSA) cycles over a period of 53 weeks.
All babies with birth weight <2000 g not on any respiratory support or phototherapy and or umbilical lines were eligible. The key quantitative outcome was KMC hours/baby/day. A QI collaborative was formed between six centres of Karnataka mentored by a team with a previous QI experience on KMC. The potential barriers for extended KMC were evaluated using fishbone analysis. Baseline data were collected over 3 weeks. A bundled approach consisting of a variety of parent centric measures (such as staff awareness, making KMC an integral part of treatment order, foster KMC, awareness sessions to parents weekly, recognising KMC champions) was employed in multiple PDSA cycles. The data were aggregated biweekly and the teams shared their implementation experiences monthly.
A total of 1443 parent-baby dyads were enrolled. The majority barriers were similar across the centres. Bundled approach incorporating foster KMC helped in the quick implementation of KMC even in outborns. Parental involvement and empowering nurses helped in sustaining KMC. Two centres had KMC rates above 10 hours/baby/day, while remaining four centres had KMC rates sustained above 6 hours/baby/day. Cross-learnings from team meetings helped to sustain efforts. Extended KMC could be implemented and sustained by low intensity training and QI collaboration.
Formation of a QI collaborative with mentoring helped in scaling implementation of extended KMC. Extended KMC could be implemented by parent centric best practices in all the centres without any additional need of resources.
袋鼠式护理（KMC）是一种经过验证的早产儿完整生存干预措施。尽管有证据表明，其采用率仍然很低。我们使用即时护理质量改进（QI）方法，通过一系列计划-执行-研究-行动（PDSA）循环，在 53 周的时间内，将稳定的低出生体重婴儿的 KMC 从基线的 1.5 小时/婴儿/天提高到 4 小时/婴儿/天以上。
所有出生体重<2000 克、未接受任何呼吸支持或光疗和/或脐带线的婴儿均符合条件。关键的定量结果是 KMC 小时/婴儿/天。卡纳塔克邦的六个中心组成了一个 QI 合作组织，由一个在 KMC 方面有 QI 经验的团队提供指导。使用鱼骨图分析评估了延长 KMC 的潜在障碍。在 3 周内收集基线数据。采用了一种以父母为中心的综合方法（如提高工作人员意识、将 KMC 作为治疗医嘱的一个组成部分、促进 KMC、每周为父母举办意识课程、识别 KMC 冠军），并在多个 PDSA 循环中实施。数据每两周汇总一次，团队每月分享实施经验。
共有 1443 对母婴参加。大多数障碍在各中心都相似。包含促进 KMC 的综合方法有助于快速实施 KMC，即使是在外出的婴儿中也是如此。父母的参与和赋予护士权力有助于维持 KMC。有两个中心的 KMC 率超过 10 小时/婴儿/天，而其余四个中心的 KMC 率维持在 6 小时/婴儿/天以上。团队会议的交叉学习有助于维持努力。通过低强度培训和 QI 合作，可以实施和维持延长的 KMC。
在指导下成立 QI 合作组织有助于扩大延长 KMC 的实施。所有中心都可以通过以父母为中心的最佳实践来实施 KMC，而无需额外的资源。
