scholarly journals Effect of a scaled-up quality improvement intervention on health workers’ competence on neonatal resuscitation in simulated settings in public hospitals: A pre-post study in Nepal

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250762
Author(s):  
Dipak Raj Chaulagain ◽  
Ashish K. C. ◽  
Johan Wrammert ◽  
Olivia Brunell ◽  
Omkar Basnet ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Health Workers ◽  
Neonatal Resuscitation ◽  
Public Hospitals ◽  
Basic Training ◽  
Knowledge Test ◽  
Improvement Project ◽  
Knowledge And Skills ◽  
Refresher Training ◽  
Over Time

Background Helping Babies Breathe (HBB) training improves bag and mask ventilation and reduces neonatal mortality and fresh stillbirths. Quality improvement (QI) interventions can improve retention of neonatal resuscitation knowledge and skills. This study aimed to evaluate the effect of a scaled-up QI intervention package on uptake and retention of neonatal resuscitation knowledge and skills in simulated settings. Methods This was a pre-post study in 12 public hospitals of Nepal. Knowledge and skills of trainees on neonatal resuscitation were evaluated against the set standard before and after the introduction of QI interventions. Results Altogether 380 participants were included for knowledge evaluation and 286 for skill evaluation. The overall knowledge test score increased from 14.12 (pre-basic) to 15.91 (post-basic) during basic training (p < 0.001). The knowledge score decreased over time; 15.91 (post-basic) vs. 15.33 (pre-refresher) (p < 0.001). Overall skill score during basic training (16.98 ± 1.79) deteriorated over time to 16.44 ± 1.99 during refresher training (p < 0.001). The proportion of trainees passing the knowledge test increased to 91.1% (post-basic) from 67.9% (pre-basic) which decreased to 86.6% during refresher training after six months. The knowledge and skill scores were maintained above the set standard (>14.0) over time at all hospitals during refresher training. Conclusion HBB training together with QI tools improves health workers’ knowledge and skills on neonatal resuscitation, irrespective of size and type of hospitals. The knowledge and skills deteriorate over time but do not fall below the standard. The HBB training together with QI interventions can be scaled up in other public hospitals. Trial registration This study was part of the larger Nepal Perinatal Quality Improvement Project (NePeriQIP) with International Standard Randomised Controlled Trial Number, ISRCTN30829654, registered 17th of May, 2017.

scholarly journals Performance of health workers on neonatal resuscitation care following scaled-up quality improvement interventions in public hospitals of Nepal - a prospective observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dipak Raj Chaulagain ◽  
Mats Malqvist ◽  
Olivia Brunell ◽  
Johan Wrammert ◽  
Omkar Basnet ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Health Workers ◽  
Clinical Performance ◽  
Newborn Infants ◽  
Neonatal Resuscitation ◽  
Public Hospitals ◽  
Intervention Package ◽  
Helping Babies Breathe ◽  
Resource Limited ◽  
Before And After

Abstract Background High-quality resuscitation among non-crying babies immediately after birth can reduce intrapartum-related deaths and morbidity. Helping Babies Breathe program aims to improve performance on neonatal resuscitation care in resource-limited settings. Quality improvement (QI) interventions can sustain simulated neonatal resuscitation knowledge and skills and clinical performance. This study aimed to evaluate the effect of a scaled-up QI intervention package on the performance of health workers on basic neonatal resuscitation care among non-crying infants in public hospitals in Nepal. Methods A prospective observational cohort design was applied in four public hospitals of Nepal. Performances of health workers on basic neonatal care were analysed before and after the introduction of the QI interventions. Results Out of the total 32,524 births observed during the study period, 3031 newborn infants were not crying at birth. A lower proportion of non-crying infants were given additional stimulation during the intervention compared to control (aOR 0.18; 95% CI 0.13–0.26). The proportion of clearing the airway increased among non-crying infants after the introduction of QI interventions (aOR 1.23; 95% CI 1.03–1.46). The proportion of non-crying infants who were initiated on BMV was higher during the intervention period (aOR 1.28, 95% CI 1.04–1.57) compared to control. The cumulative median time to initiate ventilation during the intervention was 39.46 s less compared to the baseline. Conclusion QI intervention package improved health workers’ performance on the initiation of BMV, and clearing the airway. The average time to first ventilation decreased after the implementation of the package. The QI package can be scaled-up in other public hospitals in Nepal and other similar settings.

scholarly journals Effectiveness and Acceptability of Bag-and-mask Ventilation with Visual Monitor for Improving Neonatal Resuscitation in Simulated Setting in Six Hospitals of Nepal

2019 ◽  
Vol 17 (2) ◽  
pp. 222-227
Author(s):  
Rejina Gurung ◽  
Abhishek Gurung ◽  
Priyanka Rajbhandari ◽  
Uwe Ewald ◽  
Omkar Basnet ◽  
...  
Keyword(s):  
Large Scale ◽  
Health Workers ◽  
Clinical Performance ◽  
Neonatal Resuscitation ◽  
Public Hospitals ◽  
Mask Ventilation ◽  
Air Leakage ◽  
Improvement Project ◽  
Ventilation Performance ◽  
Bag And Mask Ventilation

Background: Improving the performance of health workers on neonatal resuscitation will be critical to ensure that the babies are effectively ventilated. We conducted a study to evaluate whether a bag-and-mask ventilation with monitor is effective in improving neonatal resuscitation practice in a simulated setting. Methods: This is a cross-over design conducted in 6 public hospitals with 82 health workers of Nepal nested over a large scale stepped wedged quality improvement project. A one-day training on neonatal resuscitation was conducted. At the end of the training, participants were evaluated on the bag-and-mask ventilation performance in a manikinbased on the tidal volume, positive end expiratory pressure and air leakage from the maskin two sessions (monitor displayed versus hidden). The comparison of the neonatal resuscitation performance with and without monitor displayed is calculated. We also conducted assessment of confidence with or without monitor of the health workers. Results: Adequacy of ventilation using bag-and-mask was better when the health workers were displayed monitor (90%) vs without monitor (76%) (p<0.01). The air leakage from the mask reduced when the monitor was displayed (12%) vs without (30%). The PEEP improved when the health workers used monitor as guide to conduct neonatal resuscitation in the manikin then without monitor displayed. The participants felt more confident performing ventilations during the visible sessions. Conclusions: The ventilation function monitor helped participants to improve their ventilation skills through realtime feedback of important ventilation parameters. Clinical evaluation of needs to be done to assess the effectiveness of the device. Keywords: Clinical performance; monivent neo; neonatal resuscitation; Nepal; ventilation monitor.

scholarly journals Scaling up quality improvement intervention for perinatal care in Nepal (NePeriQIP); study protocol of a cluster randomised trial

2017 ◽  
Vol 2 (3) ◽  
pp. e000497 ◽  
Author(s):  
Ashish KC ◽  
Anna Bergström ◽  
Dipak Chaulagain ◽  
Olivia Brunell ◽  
Uwe Ewald ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Health System ◽  
Care Delivery ◽  
Perinatal Care ◽  
Randomised Trial ◽  
Scale Up ◽  
Public Hospitals ◽  
Quality Improvement Intervention ◽  
Improvement Project ◽  
Cluster Randomised

IntroductionNepal Perinatal Quality Improvement Project (NePeriQIP) intends to scale up a quality improvement (QI) intervention for perinatal care according to WHO/National guidelines in hospitals of Nepal using the existing health system structures. The intervention builds on previous research on the implementation of Helping Babies Breathe-quality improvement cycle in a tertiary healthcare setting in Nepal. The objective of this study is to evaluate the effect of this scaled-up intervention on perinatal health outcomes.Methods/designCluster-randomised controlled trial using a stepped wedged design with 3 months delay between wedges will be conducted in 12 public hospitals with a total annual delivery rate of 60 000. Each wedge will consist of 3 hospitals. Impact will be evaluated on intrapartum-related mortality (primary outcome), overall neonatal mortality and morbidity and health worker’s performance on neonatal care (secondary outcomes). A process evaluation and a cost-effectiveness analysis will be performed to understand the functionality of the intervention and to further guide health system investments will also be performed.DiscussionIn contexts where resources are limited, there is a need to find scalable and sustainable implementation strategies for improved care delivery. The proposed study will add to the scarce evidence base on how to scale up interventions within existing health systems. If successful, the NePeriQIP model can provide a replicable solution in similar settings where support and investment from the health system is poor, and national governments have made a global pledge to reduce perinatal mortality.Trial registration numberISRCTN30829654.

scholarly journals Educational sessions may not be enough to improve knowledge about hand hygiene: Assessing the knowledge about hand hygiene of health workers before and after an educational workshop in Sudan

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 449 ◽  
Author(s):  
Ihab B. Abdalrahman ◽  
Sara Shamat ◽  
Sara Mamoun ◽  
Reem Abdelraheem ◽  
Esraa Salah ◽  
...  
Keyword(s):  
Health Care ◽  
Hand Hygiene ◽  
Health Workers ◽  
Public Hospitals ◽  
World Health ◽  
Improvement Project ◽  
Before And After ◽  
Health Organization ◽  
Almost All ◽  
Educational Workshop

Background: In an attempt to defeat the high prevalence of health care associated infections, by raising the awareness about hand hygiene, we implemented a quasi-experimental study as part of a quality improvement project to evaluate the efficacy of focused educational workshop on knowledge about hand hygiene among health care workers in Sudan. Methods: Seventy-three participants were recruited from two public hospitals and one private hospital in Khartoum, Sudan in September 2017. The knowledge before and after the educational workshop was assessed for each participant using the World Health Organization hygiene associated infection questionnaire. We analyzed data using SPSS v22 and used McNemar’s test to compare knowledge before and after the workshop. Results: Around 40% of participants worked in general ward and 85% of them were women. Almost 70% were midwives or nurses. The mean age of participants was 28.4 years. We compared the knowledge of hand hygiene between nurses and doctors before the workshop, and the results showed that nurses had better knowledge in almost all aspects of hand hygiene. When we compared the knowledge before and immediately after the workshop for all participants, we found that there was no significant improvement in almost all aspects of knowledge about hand hygiene (P>0.05). Conclusion: Comparing the knowledge before and after the workshop, we found no significant improvement in almost all aspects of hand hygiene. Of note, nurses’ knowledge about hand hygiene was consistently higher than doctors.  Additional studies are needed to identify the optimal design of educational sessions.

Implementing a labor monitoring guideline and midwives responsibilities to increase the completion rate of partograph in Muhima Hospital, Rwanda

2016 ◽  
Vol 24 (4) ◽  
pp. 335-340 ◽  
Author(s):  
Jean Bosco Byukusenge ◽  
Eva Adomako ◽  
Stephanie Lukas ◽  
Cyprien Mugarura ◽  
Josette Umucyo ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Health Workers ◽  
Leadership Skills ◽  
Completion Rate ◽  
Quality Improvement Project ◽  
Completion Rates ◽  
Improvement Project ◽  
Content Type ◽  
Root Cause ◽  
Complete Health

Purpose Complete health documentation during childbirth can reduce complications and improve maternal and foetal outcomes. One such document is the partograph which allows health workers to record and follow the labour progress. However, the completion rates of partograph remain low in some hospitals. This study describes the implementation of a quality improvement project to increase the completion rate of partograph in a district hospital in Rwanda. Design/methodology/approach The project team tackled the root cause of partograph incompletion by implementing a labour monitoring guideline, assigning patients and duties to midwives and by providing support and supervision. Findings The intervention successfully increased overall partograph completion rates from 11 to 61 per cent, p < 0.001. This study also showed that completeness of the partograph was statistically associated with a decrease in foetal deaths and higher Apgar score with p < 0.001 for both. Practical implications This study describes the establishment of a quality improvement project following the strategic problem solving approach to increase the completion rate of partograph documentation. The intervention was simple, data-driven and cost-neutral. The team achieved its objectives by integrating staff input, obtaining commitment from the multidisciplinary team and applying leadership skills. Originality/value The results are useful for hospitals in limited resources settings wishing to improve overall partograph completion and improve foetal and maternal outcomes during labour, in an efficient and cost-neutral way.

scholarly journals Obstetric care navigation: results of a quality improvement project to provide accompaniment to women for facility-based maternity care in rural Guatemala

2019 ◽  
Vol 29 (2) ◽  
pp. 169-178
Author(s):  
Kirsten Austad ◽  
Michel Juarez ◽  
Hannah Shryer ◽  
Cristina Moratoya ◽  
Peter Rohloff
Keyword(s):  
Quality Improvement ◽  
Success Rate ◽  
Maternity Care ◽  
Quality Care ◽  
Obstetric Care ◽  
Public Hospitals ◽  
Statistical Process ◽  
Improvement Project ◽  
Facility Level ◽  
Poor Outcomes

BackgroundMany maternal and perinatal deaths in low-resource settings are preventable. Inadequate access to timely, quality care in maternity facilities drives poor outcomes, especially where women deliver at home with traditional birth attendants (TBA). Yet few solutions exist to support TBA-initiated referrals or address reasons patients frequently refuse facility care, such as disrespectful and abusive treatment. We hypothesised that deploying accompaniers—obstetric care navigators (OCN)—trained to provide integrated patient support would facilitate referrals from TBAs to public hospitals.MethodsThis project built on an existing collaboration with 41 TBAs who serve indigenous Maya villages in Guatemala’s Western Highlands, which provided baseline data for comparison. When TBAs detected pregnancy complications, families were offered OCN referral support. Implementation was guided by bimonthly meetings of the interdisciplinary quality improvement team where the OCN role was iteratively tailored. The primary process outcomes were referral volume, proportion of births receiving facility referral, and referral success rate, which were analysed using statistical process control methods.ResultsOver the 12-month pilot, TBAs attended 847 births. The median referral volume rose from 14 to 27.5, meeting criteria for special cause variation, without a decline in success rate. The proportion of births receiving facility-level care increased from 24±6% to 62±20% after OCN implementation. Hypertensive disorders of pregnancy and prolonged labour were the most common referral indications. The OCN role evolved to include a number of tasks, such as expediting emergency transportation and providing doula-like labour support.ConclusionsOCN accompaniment increased the proportion of births under TBA care that received facility-level obstetric care. Results from this of obstetric care navigation suggest it is a feasible, patient-centred intervention to improve maternity care.

Improving neonatal resuscitation in Tennessee: a large-scale, quality improvement project

2019 ◽  
Vol 39 (12) ◽  
pp. 1676-1683 ◽  
Author(s):  
Ajay J. Talati ◽  
◽  
Theresa A. Scott ◽  
Brenda Barker ◽  
Peter H. Grubb
Keyword(s):  
Quality Improvement ◽  
Large Scale ◽  
Neonatal Resuscitation ◽  
Quality Improvement Project ◽  
Improvement Project

scholarly journals Medical education and the quality improvement spiral: A case study from Mpumalanga, South Africa

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Martin Bac ◽  
Anne-Marie Bergh ◽  
Mama E. Etsane ◽  
Jannie Hugo
Keyword(s):  
Quality Improvement ◽  
Medical Students ◽  
Service Learning ◽  
Great Influence ◽  
Public Hospitals ◽  
Quality Improvement Project ◽  
Local Health ◽  
Medical Expert ◽  
Improvement Project

Background: The short timeframe of medical students’ rotations is not always conducive to successful, in-depth quality-improvement projects requiring a more longitudinal approach.Aim: To describe the process of inducting students into a longitudinal quality-improvement project,using the topic of the Mother- and Baby-Friendly Initiative as a case study; and to explore the possible contribution of a quality-improvement project to the development of student competencies.Setting: Mpumalanga clinical learning centres, where University of Pretoria medical students did their district health rotations.Method: Consecutive student groups had to engage with a hospital’s compliance with specific steps of the Ten Steps to Successful Breastfeeding that form the standards for the Mother- and Baby-Friendly Initiative. Primary data sources included an on-site PowerPoint group presentation (n = 42), a written group report (n = 42) and notes of individual interviews in an end-of-rotation objectively structured clinical examination station (n = 139).Results: Activities in each rotation varied according to the needs identified through the application of the quality-improvement cycle in consultation with the local health team. The development of student competencies is described according to the roles of a medical expert in the CanMEDS framework: collaborator, health advocate, scholar, communicator, manager and professional. The exposure to the real-life situation in South African public hospitals had a great influence on many students, who also acted as catalysts for transforming practice.Conclusion: Service learning and quality-improvement projects can be successfully integrated in one rotation and can contribute to the development of the different roles of a medical expert. More studies could provide insight into the potential of this approach in transforming institutions and student learning.

scholarly journals A quality improvement project focused on improving the completion of ‘notification of diagnosis’ forms for the dementia register, in an outpatient setting

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S33-S33
Author(s):  
Katherine Johnston ◽  
Lauren Megahey
Keyword(s):  
Quality Improvement ◽  
Cognitive Impairment ◽  
Outpatient Setting ◽  
Quality Improvement Project ◽  
Memory Clinic ◽  
Monthly Basis ◽  
Improvement Project ◽  
Potential Factors ◽  
The Impact ◽  
Over Time

AimsThe dementia register is designed to keep a record of all patients diagnosed with mild cognitive impairment (MCI) or dementia. Following diagnosis, a ‘notification of diagnosis’ form should be completed and the patient added to the register. The register is used to collate figures and to assess capacity and demand on services.Our baseline audit revealed suboptimal completion of these forms, therefore we initiated a quality improvement project. Our aim was to achieve completion of the ‘notification of diagnosis’ forms in 50% of new memory patients seen in clinic and diagnosed with MCI or dementia, within 3 months.MethodA baseline audit of a random sample of 52 patients, from the 380 patients on the memory clinic list was analysed. 40 of these 52 patients had a diagnosis of MCI or dementia and when cross-matched with the dementia register, only 12 (30%) of the 40 were on the register.We designed an improvement project which focused on improving awareness of the process and facilitating ease of completion of the form, for example, by placing the form in all new patients’ notes. Our results were then monitored and reviewed on a monthly basis for 3 months, to assess the impact of these changes.ResultEach month, the percentage completion of the 'notification of diagnosis' forms was calculated for new memory patients diagnosed with MCI or dementia in clinic. In the first month of the project (November 2020), 75% completion of forms was achieved. This was a significant improvement from baseline. In December, 66.7% completion was achieved (plus one patient was already on the register) and in January 2021, there was 50% completion (plus one patient was already on the register).ConclusionThe results showed an improvement in the completion of forms from baseline, and we did reach the initial aim set at 50% by 3 months. However, the trend of the results showed a steady decline in percentage completion of forms over the 3 month period. We noted that over time the forms were no longer consistently placed in the new patients’ notes, reducing accessibility to the forms. Other potential factors include a reduction in enthusiasm/ a decline in prioritisation of this project over time. Suggestions have been made to facilitate ongoing improvement and the results will continue to be reviewed.

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