Quality improvement in Kangaroo Mother Care: learning from a teaching hospital

Joshi, Amol; Londhe, Atul; Joshi, Trupti; Deshmukh, L. S.

doi:10.1136/bmjoq-2021-001459

Cited by 6 publications

(5 citation statements)

References 40 publications

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“…In a quality improvement study by Joshi et al, mothers found reclining chairs to be more comfortable than regular chairs and regular chairs were considered unacceptable for KMC sessions >1 hour. 21 Position of the infant was also shown to be a crucial aspect. Supported diagonal flexion (SDF) is an emerging concept that is shown to enhance maternal communicative behaviors and reduce the postpartum depression risk.…”

Section: (Table 2 Continued) (Table 2 Continued)mentioning

confidence: 96%

Kangaroo Mother Care Practices in Tertiary Care NICUs Across India: A Cross-sectional Questionnaire-based Survey

Rao Kodhati,

RR,

Vamsi Krishna

et al. 2024

Journal of Neonatology

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Background: KMC is a global standard for LBW and preterm neonates, supported by evidence for reducing morbidities and mortality. Integrated into India’s Newborn Action Plan since 2014, aiming for single-digit neonatal mortality by 2030, KMC practices in India have not reached the optimal levels. Hence, we attempted to study the KMC practices in tertiary care NICUs across India. Methods: A cross-sectional online national survey among neonatologists in level III NICUs in India was conducted. Utilizing Google Forms and a structured questionnaire of 30 questions on KMC, one respondent per unit participated. Results: Of the 110 NICUs invited to participate, a total of 52 units responded (47.3%). All units have a written KMC policy and conventionally provide KMC to neonates with BW < 2000 g, while 36.5% units provide KMC for neonates with BW between 2000 and 2500 g. Though 86.5% of NICUs provide KMC to infants on respiratory support, only 13.5% practice KMC for mechanically ventilated neonates. The time to initiate KMC within 48–72 hours is prevalent in 44.2% of NICUs, with 54% of NICUs providing an average KMC duration of 4–8 hours/day. A significantly lower percentage of NICUs (28.9%) have a KMC follow-up program. Conclusion: The study highlights the need to boost the ongoing KMC training programs for HCWs to increase the coverage of KMC for LBWs and sick preterm neonates. This includes requiring more uniform and structured KMC practices across the country, especially upscaling of infrastructure, earlier initiation and longer duration of KMC, better monitoring of neonates in KMC, and strengthening the follow-up program.

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Section: (Table 2 Continued) (Table 2 Continued)mentioning

confidence: 96%

Kangaroo Mother Care Practices in Tertiary Care NICUs Across India: A Cross-sectional Questionnaire-based Survey

Rao Kodhati,

RR,

Vamsi Krishna

et al. 2024

Journal of Neonatology

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“…Reducing healthcare-associated infections by improving compliance to aseptic non-touch technique in intravenous line maintenance: a quality improvement approach 16 Improving donor human milk collection in a hospital without a human milk bank: a quality improvement initiative at an urban tertiary-care teaching hospital 18 Quality improvement in Kangaroo Mother Care: learning from a teaching hospital 26 Implementing use of sucrose analgesia in a standalone private facility level 3 neonatal care unit using point of care quality improvement methodology 20…”

Section: Neonatologymentioning

confidence: 99%

Creating and sustaining a digital community of practice for quality improvement in South-East Asia during the COVID-19 pandemic

Datta,

Srivastava,

Lalwani

et al. 2023

BMJ Open Qual

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IntroductionEnsuring quality of care in Low and Middle Income countries (LMICs) is challenging. Despite the implementation of various quality improvement (QI) initiatives in public and private sectors, the sustenance of improvements continues to be a major challenge. A team of healthcare professionals in India developed a digital community of practice (dCoP) focusing on QI which now has global footprints.MethodologyThe dCoP was conceptualised as a multitiered structure and is operational online atwww.nqocncop.orgfrom August 2020 onwards. The platform hosts various activities related to the quality of care, including the development of new products, and involves different cadres of healthcare professionals from primary to tertiary care settings. The platform uses tracking indicators, including the cost of sustaining the dCoP to monitor the performance of the dCoP.ResultSince its launch in 2020, dCoP has conducted over 130 activities using 13 tools with 25 940 registration and 13 681 participants. From April 2021, it has expanded to countries across the South-East Asia region and currently has participants from 53 countries across five continents. It has developed 20 products in four thematic areas for a targeted audience. dCoP is supporting mentoring of healthcare professionals from five countries in the South-East Asia region in their improvement journey. Acquiring new knowledge and improvement in their daily clinical practice has been reported by 93% and 80% of participants, respectively. The dCoP and its partners have facilitated the publication of nearly 40 articles in international journals.ConclusionThis dCoP platform has become a repository of knowledge for healthcare professionals in the South-East Asia region. The current paper summarises the journey of this innovative dCoP in an LMIC setting for a wider global audience.

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“…These studies have tested various interventions such as awareness of staff and parents, foster KMC, simpler KMC documentation, increasing resources such as KMC chairs and provision of bed to mother, rewarding staff and parents sequentially. [14][15][16][17][18][19] Either supervision or high intensity training (>5 days training combined with >1 interactive method) alone or even in combination is unable to bring greater changes in quality care. While low intensity training combined with QI collaborative has a greater impact on improving quality care in low-income and middleincome countries.…”

Section: Available Knowledge and Rationalementioning

confidence: 99%

“…These QI initiatives have implemented KMC ranging from 2 months to 9 months. These studies have tested various interventions such as awareness of staff and parents, foster KMC, simpler KMC documentation, increasing resources such as KMC chairs and provision of bed to mother, rewarding staff and parents sequentially 14–19…”

Section: Introductionmentioning

confidence: 99%

Sustaining extended Kangaroo mother care in stable low birthweight babies in NICU: a quality improvement collaborative of six centres of Karnataka

Murthy,

Kallesh,

Somasekhara Aradhya

et al. 2023

BMJ Open Qual

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BackgroundKangaroo mother care (KMC) is a proven intervention for intact survival in preterms. Despite evidence, its adoption has been low. We used a point of care quality improvement (QI) approach to implement and sustain KMC in stable low birthweight babies from a baseline of 1.5 hours/baby/day to above 4 hours/baby/day through a series of plan-do-study-act (PDSA) cycles over a period of 53 weeks.MethodsAll babies with birth weight <2000 g not on any respiratory support or phototherapy and or umbilical lines were eligible. The key quantitative outcome was KMC hours/baby/day. A QI collaborative was formed between six centres of Karnataka mentored by a team with a previous QI experience on KMC. The potential barriers for extended KMC were evaluated using fishbone analysis. Baseline data were collected over 3 weeks. A bundled approach consisting of a variety of parent centric measures (such as staff awareness, making KMC an integral part of treatment order, foster KMC, awareness sessions to parents weekly, recognising KMC champions) was employed in multiple PDSA cycles. The data were aggregated biweekly and the teams shared their implementation experiences monthly.ResultsA total of 1443 parent–baby dyads were enrolled. The majority barriers were similar across the centres. Bundled approach incorporating foster KMC helped in the quick implementation of KMC even in outborns. Parental involvement and empowering nurses helped in sustaining KMC. Two centres had KMC rates above 10 hours/baby/day, while remaining four centres had KMC rates sustained above 6 hours/baby/day. Cross-learnings from team meetings helped to sustain efforts. Extended KMC could be implemented and sustained by low intensity training and QI collaboration.ConclusionsFormation of a QI collaborative with mentoring helped in scaling implementation of extended KMC. Extended KMC could be implemented by parent centric best practices in all the centres without any additional need of resources.

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Quality improvement in Kangaroo Mother Care: learning from a teaching hospital

Cited by 6 publications

References 40 publications

Kangaroo Mother Care Practices in Tertiary Care NICUs Across India: A Cross-sectional Questionnaire-based Survey

Kangaroo Mother Care Practices in Tertiary Care NICUs Across India: A Cross-sectional Questionnaire-based Survey

Creating and sustaining a digital community of practice for quality improvement in South-East Asia during the COVID-19 pandemic

Sustaining extended Kangaroo mother care in stable low birthweight babies in NICU: a quality improvement collaborative of six centres of Karnataka

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