scholarly journals Establishing the practice of birth companion in labour ward of a tertiary care centre in India—a quality improvement initiative

2021 ◽  
Vol 10 (Suppl 1) ◽  
pp. e001409 ◽  
Author(s):  
Juhi Bharti ◽  
Aprajita Kumari ◽  
Rinchen Zangmo ◽  
Sonia Mathew ◽  
Sunesh Kumar ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Low Cost ◽  
Tertiary Care ◽  
Fish Bone ◽  
Respectful Maternity Care ◽  
Quality Improvement Initiative ◽  
Dress Code ◽  
Tertiary Care Centre ◽  
Labour Ward ◽  
Birth Companion

BackgroundBirth companion is a key component for providing respectful maternity care and has been recommended by WHO and Government of India. It is a low-cost beneficial intervention that is vital in improving quality of care during labour and delivery.Local problemDespite the available evidence on benefits of birth companion, there was no policy on allowing birth companion at our hospital in the past.Methods and interventionsWe aimed to establish the practice of allowing birth companions in all eligible women in labour ward from existing 0% to 50% in 6 weeks’ duration. This study was conducted in the Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi. A quality improvement (QI) team was formed, and after obtaining the baseline data, problems were analysed using fish bone chart. A new policy of allowing birth companion was made and efforts made to sensitise and train the doctors and nurses posted in labour ward. Changed ideas were executed in multiple plan-do-study-act (PDSA) cycles. Simple interventions such as dress code for birth companions, curtains for ensuring privacy, display of posters and frequent reminders on WhatsApp groups were planned .ResultsThe median value of women accompanied by birth companion marginally increased to 25% after the first PDSA cycle. Implementation of further changed ideas led to increase in median, which reached 66.6%. Thereafter, there was a decline, but by the end of 6 months, it was possible to attain the goal and sustain it.ConclusionsSimple steps of QI methodology can be used to address the prevalent problems in our healthcare. Implementation of any new practice comes with major challenges, but we could achieve our goal because of a motivated team working together on multiple changed ideas applied sequentially in PDSA cycles.

scholarly journals Implementation of RMC at Tertiary Care Centre in South India

2021 ◽  
Author(s):  
Papa Dasari ◽  
Mahalakshmy Thulasingam
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Maternity Care ◽  
Tertiary Care ◽  
Respectful Maternity Care ◽  
Disrespect And Abuse ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Care Workers ◽  
Birth Companion

Title: Implementation of RMC at Tertiary Care Centre in South IndiaAbstract:Background: Disrespect and abuse experienced during childbirth has been reported by women to various sections of health care workers. The objective was to abolish Disrespect and Abuse and to bring about a policy change in labour room practices and to implement Respectful Maternity Care (RMC) in a high-volume tertiary care teaching hospital in South India.Methods: A Workshop and Continuous Medical Education Programme involving RMC experts were conducted in Phase I with defined objectives. These targeted health care workers were nurses, resident doctors, consultants, medical nursing students involved in giving care during pregnancy and labour. In Phase II the Govt. of India Policy on Birth Companion was presented in a meeting discussing on the National guidelines of “LaQshya”. Consent forms for birth companions were introduced and a dedicated public health nurse was trained to train the birth companions regarding their role in maternal support. The change of policy was officially intimated to the hospital administration. A qualitative assessment was done whether the Residents and Nurses practiced RMC as demonstrated in the Workshop. The operationalization of the birth companion policy was followed on daily observations, enquiries and onsite surprise visits over one year period.Results: The practice of RMC was followed only by few health care workers and certain cadre of women who laboured, received RMC and disrespect and abuse still prevailed. The bottle necks identified were low socioeconomic status of women, the in-charge consultants not insisting on presence of birth companions, the residents and nurses not promoting birth companion policy.Conclusions: : Implementation of Respectful Maternity Care needs change of attitudes of personnel who render care during child birth and it can only be successful unless it forms an integral part of Medical and Nursing curriculum.

Impact of targeted bundles to reduce the nebulization time gap from prescription to administration among red triaged patients in emergency department: An quality improvement initiative

2021 ◽  
Author(s):  
Seema Sachdeva seema sachdeva ◽  
Akshay Kumar Akshay Kumar ◽  
Parveen Aggarwal Parveen Aggarwal
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Fish Bone ◽  
Quality Improvement Initiative ◽  
Care Hospital ◽  
Analysis Model ◽  
Post Intervention ◽  
Targeted Interventions ◽  
Administration Time

Abstract BackgroundSevere exacerbation of asthma are potentially life-threatening and therefore require prompt care and frequent management. Important elements of early treatment includes recognition of early signs and symptoms of breathing difficulty and timely prescription and administration of therapeutic agents. A subsequent delay in receiving nebulization during an acute exacerbation of asthma can leads to cardiac arrest and even death. AimTo reduce the gap in administration of nebulization from its prescription time among red triaged patients by 50% from its baseline. Setting and designThis interventional study was conducted among red triaged patients in emergency department of tertiary care hospital, India . Material and MethodsBaseline information was collected during first 4 weeks to find gap in administration of nebulization from its prescription time. Fish bone analysis and process map were laid down to analyse the situation. The intervention using targeted bundles was done via 3 PDSA (PDSA1: indenting the nebulizers, PDSA 2: training of doctors and nurses, PDSA 3; introducing equipment checklist) to reduce the gap . A run chart using time series analysis model was used to compare the pre and post intervention nebulization gap. ResultsTotal 74 patients (30 in pre- intervention, 44 in post intervention) admitted in red triaged area were observed for nebulization gap from prescription to administration. Median time for nebulization gap before intervention was 46.5 minutes which reduced to 15 minutes in post intervention phase. ConclusionThis bundles of targeted interventions was successful to reduce the nebulization gap. Key words: nebulization gap, prescription time, administration time

Improving Hydroxychloroquine Dosing and Toxicity Screening at a Tertiary Care Ambulatory Center: A Quality Improvement Initiative

2020 ◽  
Vol 48 (1) ◽  
pp. 138-144
Author(s):  
Sahil Koppikar ◽  
Stephanie Gottheil ◽  
Chandra Farrer ◽  
Natasha Gakhal
Keyword(s):  
Quality Improvement ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Retinal Toxicity ◽  
Force Function ◽  
Quality Improvement Initiative ◽  
Toxicity Screening ◽  
Number Of Patients ◽  
Retinal Screening ◽  
Retinopathy Screening

Objective.Hydroxychloroquine (HCQ) is a commonly used weight-based medication with a risk of retinal toxicity when prescribed at doses above 5 mg/kg/day. The objectives of our study were (1) to characterize the frequency of inappropriate HCQ dosing and retinopathy screening, and (2) to improve guideline-based management by implementing quality improvement (QI) strategies.Methods.A retrospective chart review was performed to obtain baseline analysis of HCQ dosing, weight documentation, and retinal toxicity screening to characterize current practices. The primary aim was to increase the percentage of patients appropriately dosed from 30% to 90% over a 10-month period. The secondary aim was to increase the percentage of documented retinal screening from 59% to 90%. The process measure was the number of patients with a documented weight in the chart. The balancing measure was the physician’s perceived increase in time spent with each patient due to implemented interventions. QI methodology was used to implement sequential change ideas: (1) HCQ weight-based dosing charts to facilitate prescription regimens; (2) addition of scales to patient rooms to facilitate weight documentation; and (3) electronic medical record (EMR) “force function” involving weight documentation and autodosing prescription.Results.The percentage of patients being weighed increased from 40% to 92% after 10 months. Appropriate HCQ dosing improved from 30% to 89%. Retinal screening documentation improved by 33%.Conclusion.Dosing charts in clinic rooms, addition of weight scales, and EMR force function autodosing prescriptions significantly improved appropriate HCQ dosing practices. These interventions are generalizable and can promote safe and guideline-based care.

scholarly journals P042: Use of technology to create economically sustainable supplemented triage: a feasibility study at an urban tertiary care centre

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S92-S92
Author(s):  
C.H. Filipowska ◽  
L. Mazurik
Keyword(s):  
Patient Flow ◽  
Low Cost ◽  
Tertiary Care ◽  
Physician Assistants ◽  
Process Chain ◽  
Tertiary Care Centre ◽  
Use Of Technology ◽  
Average Patient ◽  
Patient Arrival ◽  
Test Ordering

Introduction: Decreasing patient Length of Stay (LOS) in the Emergency Department (ED) improves patient safety. Numerous studies have taken differing approaches to supplementing care at triage in order to decrease LOS, however, have not proven to be financially sustainable. The goal of this study was to explore financially viable options to expedite care in a safe way and reduce patient LOS. Methods: The ED process chain was identified. Two reviewers observed triage for a 4-hour period following patients. Times from patient arrival to: completion of triage, completion of registration, test ordering, physician assessment and final disposition were measured. Results were presented at departmental rounds. Nursing staff, Physician Assistants, Residents and Physician staff were paired in interdisciplinary groups to brainstorm and trial approaches to expedited test ordering and use of technology to carry out orders. Results: Triage interruptions increased time to triage a patient up to 3 times baseline, and 33% of triage interactions were interrupted. A bottleneck occurred at registration, increasing time to be registered by up to 30 minutes. Also, registration is using antiquated technology, significantly increasing registration time. Average patient LOS was 249 min, but was only 120 min if there was no delay in test ordering for patients. Average time for MD disposition was 129 min, but was only 47 minutes if there was no delay in ordering tests. Brainstorming lead to the following ideas: 1) use of companion phones to access already-working ED MD for test ordering and ECG interpretation 2) the use of the computer system to flag new orders or ECG for triage patients 3) use of a dedicated iPad in zones 4) increased standing orders for RNs to order diagnostic imaging. Conclusion: Patient LOS was reduced by lack of delay in test ordering, in keeping with previous studies. Numerous points in the process chain were identified for creating an economically sustainable supplemented triage to improve patient flow. These were: interruptions to triage, registration bottleneck, technology at registration, test ordering at triage. Ways in which to effectively order tests at triage include: MD-companion phones, pre-existing computer program, dedicated iPad in zones. The next step in this study is to trial each of these low-cost technologies.

scholarly journals Improving Respiratory Rate Accuracy in the Hospital: A Quality Improvement Initiative

2019 ◽  
Vol 14 (11) ◽  
pp. 673-677 ◽  
Author(s):  
Neil Keshvani ◽  
Kimberly Berger ◽  
Arjun Gupta ◽  
Sheila DePaola ◽  
Oanh Kieu Nguyen ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Respiratory Rate ◽  
Low Cost ◽  
Blood Pressure Measurement ◽  
Vital Signs ◽  
Safety Net ◽  
Adverse Outcomes ◽  
Quality Improvement Initiative ◽  
Safety Net Hospital ◽  
Automated Blood Pressure Measurement

Respiratory rate (RR) is a predictor of adverse outcomes. However, RRs are inaccurately measured in the hospital. We conducted a quality improvement (QI) initiative using plan-do-study-act methodology on one inpatient unit of a safety-net hospital to improve RR accuracy. We added time-keeping devices to vital sign carts and retrained patient-care assistants on a newly modified workflow that included concomitant RR measurement during automated blood pressure measurement. The median RR was 18 (interquartile range [IQR] 18-20) preintervention versus 14 (IQR 15-20) postintervention. RR accuracy, defined as ±2 breaths of gold-standard measurements, increased from 36% preintervention to 58% postintervention (P < .01). The median time for vital signs decreased from 2:36 minutes (IQR, 2:04-3:20) to 1:55 minutes (IQR, 1:40-2:22; P < .01). The intervention was associated with a 7.8% reduced incidence of tachypnea-specific systemic inflammatory response syndrome (SIRS = 2 points with RR > 20; 95% CI, –13.5% to –2.2%). Our interdisciplinary, low-cost, low-tech QI initiative improved the accuracy and efficiency of RR measurement.

scholarly journals Improving Communication Between Health Care Professionals and Parents: A Quality Improvement Initiative

2017 ◽  
Vol 4 (1) ◽  
pp. 1-9
Author(s):  
Poonam Joshi ◽  
Meena Joshi ◽  
Aakansha Sharma ◽  
Anu Sachdeva ◽  
Rajesh Sagar ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Health Care Professionals ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Parental Satisfaction ◽  
Satisfaction Score ◽  
Quality Improvement Initiative ◽  
Base Line ◽  
Team Members ◽  
Sick Neonate

This quality improvement initiative was undertaken in a tertiary care neonatal intensive care unit (NICU) to improve communication between the HCP and parents related to the sick neonates admitted in NICU as measured by increase in parental satisfaction score from base line (34.5%) to 80% in 3 months time. A team was formulated to evaluate the reasons for low parental satisfaction resulting from communication between HCP and the parents of sick neonates and to further plan strategies for improving the same. Multiple PDSA cycles were implemented. The results of the all PDSA cycles were discussed amongst team members. Satisfaction of parents related to communication with HCP increased to more than 80% in 3 months time followed by increase up to 90% in sustenance phase. Multiple simple feasible interventions led to improvement in communication between the HCP and parents as evident by increase in satisfaction score (40.8 ± 4.3 vs. 40.8 ± 4.3 vs. 91.3 ± 4.8, p < 0.001). There was significant improvement in the satisfaction scores of the mothers on communication related to sick neonate in NICU at the end of intervention phase as well as in the sustenance phase. Multiple simple doable and feasible interventions had led to the improvement in communication between the HCP and parents hence improving the satisfaction of parents related to their communication with HCP.

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