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Indian Pediatrics

Vikram Datta, Sushil Srivastava, Mahtab Singh
India contributes to the largest pool of the global neonatal and under-five mortalities. The current healthcare delivery services have a scope for improvement in terms of the quality of care at the point of delivery. In this era of resource constraints across the low- and middle-income countries (LMIC), quality improvement techniques can be a game changer to positively address the common bottlenecks of health service delivery and increase community participation. Globally, networks of quality of care and collaboratives have demonstrated significant impact in improving processes of care and the quality of services delivered to the end user...
September 15, 2018: Indian Pediatrics
Srinivas Murki, Sai Kiran, Praveen Kumar, Deepak Chawla, Anu Thukral
Across all healthcare settings, it is important not only to provide safe and effective healthcare, but also to ensure that it is timely, patient-centered, efficient and equitable. There is a wide variability in neonatal and perinatal outcomes in India and other developing countries, with certain units demonstrating clinical outcomes that match the developed world, while others showing higher than expected mortality and morbidity. Collaborative quality improvement initiatives offer a pragmatic way to improve performance of healthcare delivery within and between neonatal units...
September 15, 2018: Indian Pediatrics
Sindhu Sivanandan, Amanpreet Sethi, Meena Joshi, Anu Thukral, M Jeeva Sankar, Ashok K Deorari, Ramesh Agarwal
Quality improvement (QI) in healthcare involves implementing small iterative changes by a team of people using a simple structured framework 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 who feels intimidated to participate in change activities. In this article, we describe our experience with QI activities to address various issues in the Neonatal intensive care unit...
September 15, 2018: Indian Pediatrics
Rajesh Mehta, K Aparna Sharma
Ensuring quality in healthcare today has become extremely essential to ensure adequate utilization of healthcare services and improved outcomes. In addition to essential infrastructure in terms of safe and adequate space, knowledgeable and skilled health workers, and essential equipment and supply, the healthcare teams and administrators must also acquire knowledge and skills related to quality improvement (QI) methodologies. This review describes the role of learning platforms in teaching QI skills to the busy healthcare teams...
September 15, 2018: Indian Pediatrics
Deepak Chawla, Brian A Darlow
The 'Every Newborn Action Plan' envisions to end preventable newborn deaths and stillbirths by 2035. One important objective to realize this vision is improvement in quality of maternal and neonatal healthcare. Monitoring the performance of the healthcare systems and conducting quality improvement activities need reliable systems for data collection, analysis and interpretation. Measures chosen to monitor quality are about problems accounting for a significant health burden, for which effective interventions are available, there is evidence of variable or substandard care, and for which improvement can be undertaken by stakeholders...
September 15, 2018: Indian Pediatrics
Sindhu Sivanandan, Tavpritesh Sethi, Rakesh Lodha, Anu Thukral, M Jeeva Sankar, Ramesh Agarwal, Vinod K Paul, Ashok K Deorari
OBJECTIVE: To avoid excessive oxygen exposure and achieve target oxygen saturation (SpO2) within intended range of 88%-95% among preterm neonates on oxygen therapy. METHODS: 20 preterm neonates receiving supplemental oxygen in the first week of life were enrolled. The percentage of time per epoch (a consecutive time interval of 10 hours/day) spent by them within the target SpO2 range was measured in phase 1 followed by implementation of a unit policy on oxygen administration and targeting in phase 2...
September 15, 2018: Indian Pediatrics
Enisha Sarin, Nigel Livesley
OBJECTIVE: To compare the impact of quality improvement (QI) approaches and other health system factors (level of health facility, cadre of staff conducting the delivery, years of experience of staff conducting the delivery, and time of day) on the quality of six elements of delivery and postpartum/postnatal care. DESIGN: Cross-sectional study using external observers. SETTING: 12 public health facilities in 6 states in India during November 2014...
September 15, 2018: Indian Pediatrics
Sowmya Devarapalli, Shiv Sajan Saini, Venkataseshan Sundaram, Praveen Kumar
OBJECTIVE: To optimize utilization of laboratory tests by measuring baseline rates and appropriateness of investigations, assessing the barriers to rational use, and developing and implementing an educational package for resident doctors. DESIGN: Quality improvement study. SETTING: Neonatal intensive care unit (NICU) from August, 2015 to December, 2016. PARTICIPANTS: All neonates admitted in NICU and resident doctors working in NICU...
September 15, 2018: Indian Pediatrics
Parth Mehta, Sushil Srivastava, Divyansh Aggrohiya, Aanchal Garg
OBJECTIVE: To improve the screening rate of Retinopathy of prematurity (ROP) in the outborn neonatal intensive care unit, using the quality improvement method. METHODS: 40 neonatal nurses, 89 parents from an outborn neonatal intensive care unit of a tertiary-care hospital were included in the study between May 2017 and March 2018. Universal sampling method was used. RESULTS: In 345 neonates, ROP screening rate increased from 10.7% in the pre-intervention phase to 45...
September 15, 2018: Indian Pediatrics
Parijat Chandra, Devesh Kumawat, Ruchir Tewari, Rakesh Reddy Panyala, S S Sreeshankar
OBJECTIVE: To decrease the waiting time for preterm babies visiting the Retinopathy of prematurity clinic in a tertiary eye hospital. DESIGN: Interventional study. SETTING: Tertiary eye care hospital. PATIENTS: All preterm babies reporting for screening and follow up at Retinopathy of prematurity clinic. INTERVENTION/PROCEDURE: A quality improvement team comprising of a faculty (team leader), two senior residents, two junior residents, one nursing officer, and a registration staff was constituted...
September 15, 2018: Indian Pediatrics
Parijat Chandra, Ruchir Tewari, Yangchen Dolma, Deepsekhar Das, Devesh Kumawat
OBJECTIVE: To decrease the preoperative area waiting-time for children posted for eye surgery. METHODS: A pilot quality improvement project was conducted in a single paediatric eye operation theatre in our tertiary-care hospital. Operation theatre process flow was analyzed, baseline data was collected, and two Plan-Do-Study-Act cycles were performed on consecutive days. Average and maximal waiting-time were recorded across six operation theatre days. RESULTS: The average and maximal waiting time at baseline were 221 and 390 minutes, respectively...
September 15, 2018: Indian Pediatrics
Asim Mallick, Mukut Banerjee, Biswajit Mondal, Shrabani Mandal, Bina Acharya, Biswanath Basu
OBJECTIVE: To determine efficacy of Point-of-care Quality improvement (POCQI) in early initiation (within 30 minutes) of emergency treatment among sick neonates. DESIGN: Quality improvement project over a period of twenty weeks. SETTING: Special Newborn Care Unit (SNCU) of a tertiary care center of Eastern India. PARTICIPANTS: All consecutive sick neonates (≥ 28 wk gestation) who presented at triage during morning shift (8 am to 2 pm)...
September 15, 2018: Indian Pediatrics
Arti Maria, Amlin Shukla, Rashmi Wadhwa, Bhupinder Kaur, Bani Sarkar, Mohandeep Kaur
OBJECTIVE: To improve rate of skin-to-skin contact for early initiation of breastfeeding at birth on operation table among healthy term and late pretem babies born by caesarean sections from 0% to 80% in eight weeks. METHODS: A quality improvement initiative was undertaken at maternity-newborn care unit of a tertiary-care hospital. A team involving Neonatologists/Pediatricians, Obstetricians, Anaesthesiologists, and Nurses in concerned areas identified problem areas using Fish bone analysis...
September 15, 2018: Indian Pediatrics
Sankalp Dudeja, Pooja Sikka, Kajal Jain, Vanita Suri, Praveen Kumar
OBJECTIVE: To improve the rates of first hour initiation of breastfeeding in neonates born through cesarean section from 0 to 80% over 3 months through a quality improvement (QI) process. DESIGN: Quality improvement study. SETTING: Labor Room-Operation Theatre of a tertiary care hospital. PARTICIPANTS: Stable newborns ≥35 weeks of gestation born by cesarean section under spinal anesthesia. PROCEDURE: A team of nurses, pediatricians, obstetricians and anesthetists analyzed possible reasons for delayed initiation of breastfeeding by Process flow mapping and Fish bone analysis...
September 15, 2018: Indian Pediatrics
Seema Sharma, Chanderdeep Sharma, Dinesh Kumar
OBJECTIVE: To demonstrate the applications of the principles of Quality Improvement (QI) in a tertiary-care centre with the aim to improve the breastfeeding practices during hospital stay. METHODS: An operational team was formulated to identify the reasons for low proportion of exclusive breast feeding (EBF) in healthy neonates. Reason specific solutions were proposed, discussed, prioritized and tested using Plan-Do-Study-Act Cycle (PDSA Cycle). Strategies included clear departmental policy plan and creation of Breastfeeding support package (BFSP)...
September 15, 2018: Indian Pediatrics
Kalyan Chakravarthy Balla, Suman Pn Rao, Celine Arul, A Shashidhar, Y N Prashantha, Savitha Nagaraj, Gautham Suresh
OBJECTIVE: To study the impact of a quality improvement (QI) initiative using care bundle approach on Central-line associated bloodstream infections (CLABSI) rates. METHODS: A QI team for infection control in NICU was formed in a tertiary-care neonatal intensive care unit (NICU) from June 2015 to August 2016. Baseline data were collected over first 3 months followed by the intervention period of 1 year. Measures with respect to strengthening hand hygiene and central line bundle care were implemented during the intervention period...
September 15, 2018: Indian Pediatrics
Supreet Khurana, Shiv Sajan Saini, Venkataseshan Sundaram, Sourabh Dutta, Praveen Kumar
OBJECTIVE: To standardize and improve compliance to Aseptic non-touch techniques (ANTT) for commonly performed procedures in Neonatal intensive care unit (NICU) through application of Model for improvement, and study its impact on Healthcare-associated infection (HCAI) rates. DESIGN: Quality improvement project utilizing multiple Plan-Do-Study-Act (PDSA) cycles. SETTING: Tertiary-care neonatal unit. PARTICIPANTS: All resident doctors and nurses working in neonatal unit were subjects for assessment of compliance to ANTT...
September 15, 2018: Indian Pediatrics
Meena Joshi, Tanushree Sahoo, Anu Thukral, Poonam Joshi, Amanpreet Sethi, Ramesh Agarwal
OBJECTIVE: To increase the duration of Kangaroo mother care (KMC) in preterm infants from an average of 3 hours/day to at least 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 the Neonatal intensive care unit and KMC ward were enrolled in this study. A QI team comprising of nurses, nurse educators, resident physicians and nursing-in-charge of unit was formed...
September 15, 2018: Indian Pediatrics
Anup Thakur, Neelam Kler, Pankaj Garg, Anita Singh, Priya Gandhi
OBJECTIVE: To improve the usage of expressed breast milk in very low birth weight infants admitted in the neonatal intensive care unit of a tertiary centre in India. METHODS: Between April 2015 and August 2016, various Plan-do-act-study cycles were conducted to test change ideas like antenatal counselling including help of brochure and video, post-natal telephonic reminders within 4-6 hours of birth, standardization of Kangaroo mother care, and non-nutritive sucking protocol...
September 15, 2018: Indian Pediatrics
Ashok Deorari, Nigel Livesley
No abstract text is available yet for this article.
September 15, 2018: Indian Pediatrics
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