Table 4

Summary of interventions in improvement phase

PDSAPlanDoStudyAct
KMC tools: for privacyTo modify the front open hospital gown as per the requirement to check if one flap (size 25 cm×25 cm) in the front sufficesTailor modified the hospital supplied front open gown as per suggestions by mother and female staff nurseIdea feasible. Flap size adequate and
KMC possible without compromising privacy. Baby’s monitoring possible		Adopted.
All gowns with a front flap
To reduce interruptionsTo perform time-motion analysis over 3 days (Saturday to Monday) for medical, personal and social reasons. and to test different ideas to minimise interruptions over 10 daysThe on-duty nurse in each shift noted time-wise interruptions and tried Kangaroo walk during mopping. Feeding frequency changed from two to three hourlyTime adjustment for NICU chores possible.
Scheduling of housekeeping, clustering of care and Kangaroo walk helped		Adapted as it resonated clustering of care
To check if different types of breast pumps help reduce interruption during the expression of milk.

  • Breast pump with rubber bulb (INR 80).

  • Piston based breast pump (INR 550).

  • Electric breast pump (INR 1500).

  • Hospital-grade breast pump (INR 20 000).

On-duty staff counselled mothers to buy and try a pump of choice (except the hospital grade) and team members took feedback over 3 days

  • Pump with a rubber bulb could not generate enough pressure.

  • Piston required two hands.

  • Electric pump generated enough pressure, but sterilisation of milk contact surfaces not possible.

  • Hospital-grade pump costly, was more comfortable, without much change in KMC hours.

Adapted.
Manual expression with assistance continued, and two hospital-grade pumps made available to the unit with funding
KMC blockTo designate distant located level II care NICU block for KMCKMC block set with permission from hospital administration. KMC eligible babies admitted to that blockIt was feasible.
Resource allocation was easy. The area was nearer to the postnatal ward. Policy to allow more than one caregiver was possible in this separate area		Adopted.
The team applied for funding support

  • Some of these PDSA were not in the same temporal sequence as displayed in the table. We executed one change idea at a time though more than one is shown in a row in some cases in this table.

  • KMC, Kangaroo Mother Care; NICU, neonatal intensive care unit; PDSA, Plan-Do-Study-Act.