A quality improvement study aimed to increase the average duration of KMC per baby per day in admitted eligible preterm mother-infant pair in a Tertiary care NICU in Ahmedabad, Western India, from the current baseline

Abstract

IntroductionKangaroo mother care (KMC) is a cost-effective, evidence-based intervention for preterm and low-birth-weight (LBW) infants. KMC offers several advantages, such as improved growth and sustained long-term development. Despite its numerous benefits, the adoption and implementation of KMC have been minimal. The number of hours that KMC is practiced remains minimal, even in facilities where it is already implemented. There are a number of possible obstacles to KMC, such as problems with the surroundings and resources of the facilities, unfavourable perceptions of the attitudes of the employees, and not enough knowledge about the advantages of KMC (Seidman et al., 2015). ObjectiveTo effectively address this issue, a Quality Improvement (QI) study was initiated with a SMART goal: to increase the duration of Kangaroo Mother Care (KMC) in our unit from a baseline average of 2 h per baby per day to an average of 6 h per baby per day within 6 weeks for all stable newborns weighing less than 2.5 kg. MethodsEach eligible mother-infant pair was considered a single participant in this study. We have included all eligible preterm neonates admitted to the NICU. We have excluded sick neonates who needed invasive or non-invasive mechanical ventilation (NIMV), those who were experiencing shock or hemodynamic instability, neonates undergoing phototherapy, neonates without eligible relatives, or mothers who were ill and incapable of providing KMC. Data was gathered during the baseline phase using a pre-designed form for ten days from ten eligible pairs of preterm infants and their mothers. During our initial Quality Improvement meeting, we assessed the challenges that were encountered by both mothers and staff in delivering Kangaroo Mother Care for a particular time frame using a different form.The challenges were identified by fishbone analysis. A substantial enhancement package for the Kangaroo Mother Care (KMC) was proposed. We identified potential interventions based on this data. The changes underwent testing as part of the Plan-Do-Study-Act (PDSA) cycle. We completed six PDSA cycles. Several measures were implemented and tested through multiple plan-do-study-act (PDSA) cycles. Results88 mother-infant pairs took part in the 6-week implementation phase. We accomplished our objective by gradually implementing modifications using six PDSA cycles. The duration of Kangaroo Mother Care (KMC) was increased to 6 h daily during a span of 6 weeks. Assessment at 4 and 9 weeks after implementation indicated that the increased KMC length was maintained at 6.7 h every day in the unit. ConclusionImplementing basic measures as part of a quality improvement project, together with increased maternal education and family participation, can greatly extend the duration of Kangaroo Mother Care and contribute to overall enhancement.Category.