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.