Quality improvement initiative to improve the duration of kangaroo mother care for twin preterm neonates born at a tertiary care hospital in resource‐limited settings

Abstract

Aim Kangaroo mother care (KMC) can be challenging in multiple births and more so in resource‐limited settings. This study aims at increasing the mean duration of KMC with early initiation in twin preterm neonates born at a tertiary care hospital using a quality improvement (QI) initiative. Methods Barriers for poor KMC practice in twin preterm neonates born at the tertiary care hospital were analysed and baseline data were collected over a period of 4 months using a predesigned proforma. A QI team was formed and suggested solutions were prioritised through focus group discussions in the form of Plan‐Do‐Study‐Act (P‐D‐S‐A) cycles. Each cycle was of one‐month duration and three cycles were implemented, followed by the sustenance phase studied at 1‐month post‐implementation. Results There were a total of 238 twin deliveries in the study period, of which 169 twin pairs were included in the study. At the end of implementation, the average day of initiation of KMC improved from 8th to 3rd day of life and the duration of KMC increased significantly from an average of 2.70 h/infant/day to 7.88 h/infant/day. Conclusion This QI project focused on the improvement of KMC practice in twin preterm neonates in a tertiary care hospital where results were achieved with maximal utilisation of available hospital resources and low‐cost interventions. This study design is generalizable to other hospitals in resource‐limited settings where family participatory care can be strengthened to overcome the challenges of KMC in multiple births.

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

“…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.…”

“…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…”

Twins with Craniosynostosis: An Unidentified Variant/Twin Research: Kangaroo Care for Premature Twins; Developmental Delay in MZ Twins; Osteosarcoma in One Identical Twin; Controversies in Twin Pregnancy Management/Media Reports: Twin and Triplet Olympians; Twin’s Rescue from a Crocodile; Twin Pandas in Japan; Twin Surrogacy; Identical Twins in Pennsylvania

“…A program aimed to increase the practice of KC for twins born at tertiary care hospitals, known as the quality improvement (QI) project, was undertaken by researchers in Bengaluru, India (Arora et al, 2021). (Tertiary hospitals offer specialized treatment at a high level of care; Torrey, 2021).…”

Kangaroo Mother Care Practices: Sustainability Is Important

“…While the first study suggested that the duration of KMC improved [5], the second study also suggested an improvement in the timing of initiation of KMC. The average day of initiation of KMC improved from 8th to 3rd day of life [6].…”

“…Two recent studies suggested an improvement in KMC duration [5,6] through a quality improvement (QI) approach in a tertiary-care neonatal unit. A QI team was formed, solutions were prioritised through focus group discussions and implemented through Plan-Do-Study-Act (PDSA) cycles.…”