ABSTRACT
Background: Breastfeeding is a well-established key of success to improve the outcome in neonates. Early initiation of breastfeeding in neonates refers to the provision of mother's milk to their own babies as early as possible after delivery. Despite the established benefits of breastfeeding, early initiation of breastfeeding is found to be suboptimal in our country. Early initiation of breastfeeding has many challenges like no bedding in, availability of lactation counsellors and staff nurses, procedural delay (episiotomy, skin suture) and shifting from the recovery room. Objective of the study was to improve the rate of initiation of breastfeeding stable term and preterm neonates within 1 hour of life in both normal vaginal delivery and caesarean section conducted in our hospital from baseline to 95% over 3 months period by Quality improvement approach.Methods: Eligible inborn mother-infant dyads were enrolled in this study. A team formed, baseline data and rate of early initiation of breastfeeding collected and factors for delayed initiation analysed by Flowchart process, Fishbone analysis and 5 why's, 3 PDSA cycles were done.Results: Total 50 mother-infant dyads assessed. Rate of early initiation of breastfeeding within 1 hour of life increased from 25% to 100% over 3 months.Conclusions: This quality improvement study was able to accomplish sustained improvement in the rate of breastfeeding the neonates in the first hour of life.
ABSTRACT
Objective: To decrease the preoperative area waiting-time forchildren posted for eye surgery.Methods: A pilot quality improvement project was conducted in asingle paediatric eye operation theatre in our tertiary-carehospital. Operation theatre process flow was analyzed, baselinedata was collected, and two Plan-Do-Study-Act cycles wereperformed on consecutive days. Average and maximal waiting-time were recorded across six operation theatre days.Results: The average and maximal waiting time at baseline were221 and 390 minutes, respectively. After two rapid Plan-Do-Study-Act cycles, these were reduced to 29 (87% reduction) and 52minutes (87% reduction) from baseline, respectively, and couldsubsequently be sustained.Conclusion: Preoperative waiting time in ophthalmic operationtheatre was significantly reduced by simple process flowoptimization, thereby improving quality of care.
ABSTRACT
Objective: To improve the rates of first hour initiation ofbreastfeeding in neonates born through cesarean section from 0to 80% over 3 months through a quality improvement (QI)process.Design: Quality improvement study.Setting: Labor Room-Operation Theatre of a tertiary carehospital.Participants: Stable newborns ?35 weeks of gestation born bycesarean section under spinal anesthesia.Procedure: A team of nurses, pediatricians, obstetricians andanesthetists analyzed possible reasons for delayed initiation ofbreastfeeding by Process flow mapping and Fish bone analysis.Various change ideas were tested through sequential Plan-Do-Study-Act (PDSA) cycles.Outcome measure: Proportion of eligible babies breast fedwithin 1 hour of delivery.Results: The rate of first-hour initiation of breastfeeding increasedfrom 0% to 93% over the study period. The result was sustainedeven after the last PDSA cycle, without any additional resources.Conclusions: A QI approach was able to accomplish sustainedimprovement in first-hour breastfeeding rates in cesareandeliveries.