Table 1

Details of the PDSA cycles

Sustenance (n=694)
When1 Nov 2018–30 Nov 20181 Dec 2018–31 Dec 20181 Jan 2019–31 Jan 20191 Jan 2019–31 Dec 2020
PlanSensitisation & reminders at workplaceReminder of DCC prior to deliverySimpler system of data collectionSustain improvement
DoTeaching sessions thrice weekly with the nurses. WhatsApp reminder after each admission. Pictorial poster display in resuscitation area reminderContinue 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 DCCData entry in delivery register and updated on daily dashboardPre-delivery reminder. Data collection in delivery register and dashboard. Monthly display of results. Celebrations and incentivise QI champions
StudyCompliance DCC=42%, EBFI=100%, WhatsApp reminders=26%. Lack of communication at admission of probable delivery cases to the resuscitation teamCompliance 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 collectionCompliance DCC=100%, EBFI=83%. New system of data collection was well acceptedCompliance DCC=96%, EBFI=97%.
Quality of DCC was also recorded from August 2019. DCC and EBFI part of monthly quality indicators
ActEBFI improved with teaching. Instead of a reminder of DCC at admission, try reminding just before delivery. Abandon WhatsApp reminderAdopt pre-delivery reminder and weekly team huddle. Continue recording and displaying data. Try data collection in an easier wayAdopt the new system of data collection. Sustain changesPre-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.