Quality improvement initiative: improving proportion of preterm infants on mothers only milk at the time of discharge

Background: Availability of mothers only milk (MOM) for preterm infants is a boon for their growth and development. Authors found that in our Special Newborn Care Unit (SNCU), the availability of MOM was very less with excessive use of formula feed. So, authors planned a quality improvement (QI) study to improve availability of MOM for preterms in level 3 SNCU catering to both in-born and out-born neonates.Methods: Authors aimed to improve availability of MOM to preterm infants admitted in SNCU from the current 10% to 80% at day 7 of admission over a period of 8 weeks. Authors included preterm and mother dyads with <34 weeks of gestation or having birth weight <1800 gm. and likely to stay in SNCU for at least a week. For this initiative a QI team was formed. Baseline data was collected for a period of 3 weeks and analysis was performed of various constrains in providing MOM to preterms was later an interventional package was implemented which included counselling to mothers, Kangaroo mother care (KMC), demonstration of milk expression techniques. Intervention phase was implemented for the period of 8 weeks followed by sustenance phase for 2 months.Results: Proportion of preterm infants on MOM increased from 10% to 81% during intervention phase at day 7 of admission and remained 66% during sustenance phase.Conclusion: QI initiative has the potential to bring a tremendous change in making mothers milk available to both inborn and out-born preterms. With existing resources simple interventions can increase availability of MOM to preterm infants.

Prophylactic Vitamin K Administration in Neonates on Prolonged Antibiotic Therapy: A Randomized Controlled Trial

Objective: To compare the prevalence of vitamin K deficiencyafter intramuscular vitamin K or no treatment in neonates withsepsis on prolonged (>7 days) antibiotic therapy.Study Design: Open label randomized controlled trial.Setting: Level 3 Neonatal Intensive Care Unit (NICU).Participants: Neonates with first episode of sepsison antibioticsfor ≥7 days were included. Neonates with clinical bleeding,vitamin K prior to start of antibiotic therapy (except the birth dose),cholestasis or prenatally diagnosed bleeding disorder wereexcluded.Intervention: Randomized to receive 1 mg vitamin K (n=41) or novitamin K (n=39) on the 7th day of antibiotic therapy.Main outcome measure: Vitamin K deficiency defined as ProteinInduced by Vitamin K Absence (PIVKA-II) >2 ng/mL after 7 ± 2days of enrolment.Results: The prevalence of vitamin K deficiency was 100%(n=80) at enrolment and it remained 100% even after 7 ± 2 days ofenrolment in both the groups.Conclusion: Neonates receiving prolonged antibiotics haveuniversal biochemical vitamin K deficiency despite vitamin Kadministration on 7th day of antibiotic therapy.

Gains from Quality Improvement Initiatives – Experience from a Tertiary-care Institute in India

Quality improvement (QI) in healthcare involves implementing small iterative changes by a team of people using a simple structuredframework to resolve problems, improve systems, and to improve patient outcomes. These efforts are especially important in a resource-limited setting where infrastructure, staff and funds are meagre. The concept of QI often appears complex to a new careprovider whofeels intimidated to participate in change activities. In this article, we describe our experience with QI activities to address various issuesin the Neonatal intensive care unit. QI efforts resulted in improved patient outcomes, and motivated careproviders. QI is a continuousactivity and can be done easily if the team is willing to learn from their experiences and use those lessons to adapt, adopt or abandonchanges, and improve further. Our institute has also developed Point of Care Quality Improvement (POCQI), a free online resource forlearning the science of QI, and also serves as a platform for sharing QI work.

Improving Duration of Kangaroo Mother Care in a Tertiary-care Neonatal Unit : A Quality Improvement Initiative

Objectives: To increase the duration of Kangaroo mother care(KMC) in preterm infants from an average of 3 hours/day to atleast 6 hours/day over 7 weeks through a Quality improvement(QI) approach in a tertiary-care neonatal unit.Methods: Preterm mother-infant dyads who were admitted in theNeonatal intensive care unit and KMC ward were enrolled in thisstudy. A QI team comprising of nurses, nurse educators, residentphysicians and nursing-in-charge of unit was formed. Thepotential barriers for prolonged KMC were evaluated using fishbone analysis. A variety of measures (allowing family membersincluding male members during night for doing KMC, makingKMC an integral part of treatment order, introducing the concept ofweekly KMC champions, etc.) were introduced and subsequentlytested by multiple Plan-do-study-act (PDSA) cycles. Data onduration of KMC per day was measured by bedside nurses ondaily basis.Results: 20 eligible mother-infant dyads were studied duringimplementation period (50 d). The mean (SD) weight andgestation of infants were 1199 (356) g and 31.1 ( 2.3) wks,respectively. We achieved our goal by step-wise implementationof changes through construction of 3 PDSA cycles. The durationof KMC increased to 6 hours-a-day over a period of 7 weeks.Evaluation at 6 and 12 months in the post-implementation phasesuggested sustenance of improved KMC duration up to 9 h/day inthe unit.Conclusions: Ongoing quality improvement measures increasedthe duration of KMC from a baseline of 3 h to 6 h in eligible preterminfants, and the results were sustained at 6-12 month.