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

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