PT  - JOURNAL ARTICLE
AU  - Gayathri Ramachandrappa
AU  - Abhishek Somasekhara Aradhya
AU  - Latha Mercy
AU  - Anil Kumar
AU  - Praveen Venkatagiri
TI  - Sustaining prolonged kangaroo mother care in stable low birthweight babies over 2 years in a predominant outborn unit: a quality improvement approach
AID  - 10.1136/bmjoq-2021-001771
DP  - 2022 Oct 01
TA  - BMJ Open Quality
PG  - e001771
VI  - 11
IP  - Suppl 1
4099  - http://bmjopenquality.bmj.com/content/11/Suppl_1/e001771.short
4100  - http://bmjopenquality.bmj.com/content/11/Suppl_1/e001771.full
SO  - BMJ Open Qual2022 Oct 01; 11
AB  - Background Kangaroo mother care (KMC) is a proven intervention for improving intact survival in low birthweight babies. Despite the evidence, its adoption and implementation have been low. Availability of mothers for the first few days of life is a specific challenge at outborn units. We used a quality improvement (QI) approach to implement and sustain KMC in stable low birthweight babies (<2000 g) from a baseline of 2.7 hours/baby/day to 6 hours/baby/day (prolonged KMC) over a period of 2 years in our unit through a series of Plan-Do-Study-Act (PDSA) cycles.Methods All babies with birth weight <2000 g not on any respiratory support or jaundice were eligible. The key quantitative outcome was KMC hours/baby/day. A QI team consisting of nurses, nursing in charge and consultants of the unit was formed. The potential barriers for prolonged KMC were evaluated using fishbone analysis. A variety of parent-centric measures (provision of bed to mothers apart from KMC chairs, foster KMC, structured KMC counselling through a video, making KMC an integral part of treatment order) were introduced and subsequently tested by multiple PDSA cycles. Data on the duration of KMC per day were measured by bedside nurses on a daily basis.Results A total of 134 mother–baby dyads were enrolled over 2 years. The mean gestation (SD) and mean birth weight (SD) were 33 (2) weeks and 1557 (295) g, respectively. 78 (58%) babies were outborns. We implemented prolonged KMC over 9 months and sustained it over the next 18 months. KMC duration increased from a median of 2.7 hours/baby/day from baseline to a median of 7.4 hours/baby/day after implementation.Conclusions Prolonged KMC could be implemented and sustained over 2 years by implementing parent-centric best practices even in a predominant outborn unit.All data relevant to the study are included in the article or uploaded as supplementary information.