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Point of Care Quality ImprovementWHO Collaborating Center for Training and
Research in Newborn Care
www.aiimsqi.org
MEDICAL COLLEGES AS RESOURCES FOR A DISTRICT/STATE LEVEL QUALITY IMPROVEMENT
PROGRAMWEST BENGAL EXPERIENCE
Prof. Dr. Asim Kumar Mallick In-charge Neonatal Unit NRS Medical College and Hospital Kolkata, West Bengal, India
Point of Care Quality ImprovementWHO Collaborating Center for Training and
Research in Newborn Care
1st QI Workshop July, 2016
• 4 Medical Colleges - SSKM, NRS, CMC, R.G.Kar
• Doctors & Nurses
• Faculty: Prof Dr. A.K. Deorari (AIIMS), Dr. Anu Sachdeva,
Dr. Seema Singhal, Dr. Nigel Livesley (USAID ASSIST)
• 6 QI projects taken up
Sharing successful QI Projects with Leadership Sep, 2016
Stakeholders : Director NHM, Chairman High Level Task Force, Prof. Deorari, DME
District quality improvement workshop for medical officers & nurses, Dec 2016
Other medical colleges and district hospital staff trained in QI – 40 participants
Facilitated by – R.G.Kar and other WB Medical Colleges and AIIMS
QI Projects
• To increase the use of corticosteroid in antenatal period (≤ 34 weeks) existing 40 % to at least 80% within 6 wks.
• Decrease the incidence of hypothermia of all healthy newborn weighing 1500gm to 1800gm at the time admission in SNCU from 100% to zero by 6 weeks.
• Reduce the mean duration of stay of healthy babies in SNCU (MCH)
• We aim to achieve Clean Delivery Techniques comprising Clean Hands, Clean Perineum, and Clean Surface in all patients undergoing vaginal delivery in our LR from 10% to 50% by 2 months in two units
• Reduce incidence of nasal injury in preterm babies, receiving CPAP, inside NICU
• To increase the attendance of mothers for EBM on D1 from 0% to 30%
Increase the use of corticosteroid in ANC• Aim - To increase the use of corticosteroid in
antenatal period (≤ 34 weeks) existing 40 % to at least 80% within 6 wks.
Presented by : Dr. Samaresh Malo. Asst. Prof. G&O
Baseline - Among mothers of less than 34 weeks
who got admitted only 40% of them received
full dose of steroids.
10 10 10
0
3
5
8
10
QUALITY IMPROVEMENT IN RECEIVING
ANC STEROIDS
No. of subjects
Pts receiving steroid(%)
Reduce hypothermia in newborns• Decrease the incidence of hypothermia of
all healthy newborn weighing 1500gm to 1800gm at the time admission in SNCU from 100% to zero by 6 weeks.
THE USUAL PRACTICE IN LABOR
ROOM BEFORE QI
PROPER SSC JUST AFTER
DELIVERY AFTER QI
Presented by : Sr. Ushosee Ghosh, Sister In-charge, SNCU
33.8
34.5
35.3
36.
36.8
1 3 5 7 936.4
36.5
36.6
36.8
36.9
37.
1 2 3 4 5
34.5
35.
35.5
36.
36.5
37.
1 2 3 4 5
HYPOTHERMIA – 100% HYPOTHERMIA – 60% HYPOTHERMIA – 0%
30
60
96
90
83
100
84
30
48
75
85 83
100
80
30
52
63
80
88
100 100
0
25
50
75
100
125
1 2 3 4 5 6 7
H P T
• Presented by :Dr.Mallika Datta - Assistant Professor Ob Gyn
Improve Clean Delivery Techniques
CMC :Display of poster and sister demonstrating steps of hand washing
We aim to achieve Clean Delivery Techniques comprising Clean Hands, Clean Perineum, and Clean Surface in all patients undergoing vaginal delivery in our LR from 10% to 50% by 2 months in two units
Reduce incidence of nasal injury in preterm babies receiving CPAP
Reduce incidence of nasal injury in preterm
babies, receiving CPAP, in the NICU from 1)
reduce nasal bridge injury from 50% to 20% 2)
reduce columella injury from 17% to 0% within 6
weeks
Results
• Columella injury is reduced to 0%
• Nasal bridge injury is reduced to 16%
Columellainjury
Nasal bridge injury
Presented by :Sr. Baby Mondal, Nursing tutor
Weekly data for 3 months QI Project period(June-August) Avg 23.92 hrs/baby
Weeks
June - Base line data(Avg duration 61.78 hrs)
Reduce the mean duration of stay of healthy babies in SNCU (MCH)
Presented by : Dr. Gargi Gayen (Asst Prof Neonatology)
• Mothers are coming for EBM after 3 to 4 days
• Frequency of attendance for EBM very irregular
• At night mothers are not coming for EBM
Problems identified
0 0
60
160
278
5060
135
240 245
0
75
150
225
300
Day 1 Day 2 Day3 Day4 Day 5
Before QI
After QI
Providing EBM on D1 in SNCU of R.G.Kar Medical College
Presented by :Sr. Smritilata Konar, Sister
To increase the attendance of mothers for EBM on D1 from 0% to 30%
Video demonstration on EBM to groups
SUCCESSFUL QI PROJECT:
3rd QI workshop July, 2017
• Stakeholders : DME, DHS, Director of NHM, SFWO, Chairman HLTF, UNICEF
Chief, HOD Pediatrics of all Medical colleges, HOD G&O of all Medical colleges,
Principal and MSVP of all Medical colleges, Nursing Superintendent of Different
Medical Colleges and QA Official
• Faculty: Prof Dr Vinod K Paul, AIIMS, USAID ASSIST, Government Medical
College, Chandigarh
• 90 participants
• Sample Projects taken up
• Increase delayed cord clamping in all term babies delivering normally from 20% to 80% in 8 wks
• Handwash before vaginal examination in labour room fro 40% to 60% in 6 weeks
• Increase percentage of partograph during labour from 30% to 90% in 4 weeks
• Post operative management according to state format for first 6 hours in post operative LSCS
cases from 30% to 60% in 6 weeks
Projected Levels of Neonatal Mortality Rates in India: 2012-2030
ACTION PLANCore team : DME,DHS,MD NHM,Chairman
HLTF,SFWO
Pediatrics
Mentor
SNCU FBNC Cell Obstetric Cell
G&O Mentors
DH/SDH
>3000 Delivery
Summary of WB experience
Now the medical college faculty is providing technical guidance to the Govt. of WB on setting up a system for doing QI statewide
Leadership and stakeholders kept informed from the beginning
These Medicine Colleges then had the experience to teach QI to other medical colleges and district hospitals
These Medical Colleges did their own quality improvement projects
Four Medical Colleges Learnt how to do QI with support from AIIMS & USAID ASSIST
Scope for Quality Improvement
• Labour Monitoring • Timely Referral • Timely Intervention, including CS• Neonatal Resuscitation Skills & Practice• Review of Stillbirths• Postpartum Care• Counseling, behavior and support to mothers: EIBF, KMC, LAMA• Handwashing• Asepsis & Antibiotic Usage• Segregation of Waste
ACKNOWLEDGEMENT
Prof Deorari and AIIMS Team
Dr Nigel and USAID ASSIST Team
Govt. of West Bengal
MD NHM and Chairman HLTF
17
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