Details of the PDSA cycles
| PDSA | 1 (n=20) | 2 (n=15) | 3 (n=18) | Sustenance (n=694) |
| When | 1 Nov 2018–30 Nov 2018 | 1 Dec 2018–31 Dec 2018 | 1 Jan 2019–31 Jan 2019 | 1 Jan 2019–31 Dec 2020 |
| Plan | Sensitisation & reminders at workplace | Reminder of DCC prior to delivery | Simpler system of data collection | Sustain improvement |
| Do | Teaching sessions thrice weekly with the nurses. WhatsApp reminder after each admission. Pictorial poster display in resuscitation area reminder | Continue sensitisation sessions weekly as part of team huddle. Reminder of DCC as part of pre-delivery checklist. Continue recording EBFI rates. Qualitative experience of nurses on DCC | Data entry in delivery register and updated on daily dashboard | Pre-delivery reminder. Data collection in delivery register and dashboard. Monthly display of results. Celebrations and incentivise QI champions |
| Study | Compliance DCC=42%, EBFI=100%, WhatsApp reminders=26%. Lack of communication at admission of probable delivery cases to the resuscitation team | Compliance DCC=83%, EBFI=83%. Pre-delivery reminders helped in improving DCC. EBFI improved as a co-intervention without any specific strategy. Qualitative experience revealed challenges in data collection | Compliance DCC=100%, EBFI=83%. New system of data collection was well accepted | Compliance DCC=96%, EBFI=97%. Quality of DCC was also recorded from August 2019. DCC and EBFI part of monthly quality indicators |
| Act | EBFI improved with teaching. Instead of a reminder of DCC at admission, try reminding just before delivery. Abandon WhatsApp reminder | Adopt pre-delivery reminder and weekly team huddle. Continue recording and displaying data. Try data collection in an easier way | Adopt the new system of data collection. Sustain changes | Pre-delivery reminder and display of results sustained the change |
DCC, delayed cord clamping; EBFI, early breastfeeding initiation; PDSA, plan–do–study–act; QI, quality improvement.