Table 2

Details of the PDSA cycles

When1 February 2019 to 10 March 201920 March 2019 to 20 July 201910 August 2019 to 15 October 201920 October 2019 to 30 April 2021
PlanTraining nurses, provision of bed.Remove visiting restrictions for fathers/grandmothers for doing KMC.Reduce variation in counselling.Sustain KMC-QI champion and recognition, simpler data collection.
DoHalf-day KMC training session for all nurses, HDU 2/4 beds marked for KMC. Track KMC rates.Foster KMC posters, change visiting restrictions policy, foster KMC was emphasised in daily counselling sessions.Structured counselling of mothers for KMC using a standard video.QI champions—cake cutting and celebrations, data collection on daily dashboard, KMC part of discharge policy, display run charts monthly.
StudyKMC increased from 2.7 to 5 hours/baby/day. Availability of mothers is a concern.KMC increased from 5 to 5.7 hours/baby/day. Mother had concerns if there was no weight gain despite KMC and less motivation.KMC increased beyond 6 hours/baby/day.Prolonged KMC could be sustained for nearly 18 months despite COVID-19 pandemic.
ActTry foster KMC with father/grandmothers.Continue foster KMC and attempt structured counselling of mothers.Sustain KMC.Continued sustenance. SOP for prolonged KMC.
  • HDU, high dependency unit; KMC, kangaroo mother care; PDSA, Plan-Do-Study-Act; QI, quality improvement; SOP, standard operating procedure.