Kangaroo mother care utilization at stepdown ward of a tertiary care teaching hospital: a quality improvement study

Abstract

Purpose: India has the highest burden of preterm/low birth weight newborns. To tackle this, Kangaroo Mother Care (KMC) needs to be scaled up. We did a quality improvement (QI) study to increase KMC coverage to 80% and its utilization to at least 4 h/infant/day.

Methods: This study was conducted at a stepdown ward (KMC ward) of a tertiary care teaching institute over a period of four months. All babies with birth weight <2.5 kg were eligible. The QI team included faculty in-charge, one senior resident and three senior staff nurses. Potential barriers were listed using fish-bone analysis. Four possible interventions were identified (daily documentation of total KMC hours by doctor, providing KMC during all the nursing duty shifts, counseling and education to mothers and family members), introduced, and then subsequently tested by four Plan-Do-Study-Act (PDSA) cycles and sustenance was assessed over three months.

Results: A total of 93 infants were included in this QI study. During baseline phase, the KMC coverage was 50% which increased to 100% by the end of fourth PDSA cycle and remained 100% during the sustenance phase. During baseline period, KMC was given for ≥ 4 h in 18.8% (28 of 149) patient days which increased to 88.96% (137 of 154) during the sustenance phase. The mean KMC utilization increased from 1.97 (1.57) h/infant/day to 5.65 (1.20) h/infant/day in the sustenance phase.

Conclusion: QI study incorporating PDSA cycles helped improve coverage and utilization of KMC.

Keywords: counselling; documentation; low birth weight; nurses; skin-to-skin contact.