Summary of interventions in improvement phase
PDSA | Plan | Do | Study | Act |
KMC tools: for privacy | To modify the front open hospital gown as per the requirement to check if one flap (size 25 cm×25 cm) in the front suffices | Tailor modified the hospital supplied front open gown as per suggestions by mother and female staff nurse | Idea feasible. Flap size adequate and KMC possible without compromising privacy. Baby’s monitoring possible | Adopted. All gowns with a front flap |
To reduce interruptions | To 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 days | The on-duty nurse in each shift noted time-wise interruptions and tried Kangaroo walk during mopping. Feeding frequency changed from two to three hourly | Time 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.
| 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 |
| Adapted. Manual expression with assistance continued, and two hospital-grade pumps made available to the unit with funding | |
KMC block | To designate distant located level II care NICU block for KMC | KMC block set with permission from hospital administration. KMC eligible babies admitted to that block | It 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.