Quality improvement initiative to improve the duration of Kangaroo Mother Care in tertiary care neonatal unit of South India

BACKGROUND: India has the highest number of preterm births and maximum number of deaths due to prematurity. Chengalpattu Government Medical College had 11 593 deliveries annually in 2020, of which 2252 of neonates were low birth weight. 2016 Cochrane review concluded that Kangaroo Mother Care (KMC) reduces the morbidity and mortality in low birthweight infants. The average duration of KMC in our unit was around 4.6 hours/baby/day. OBJECTIVE: To improve the duration of KMC in stable low birthweight babies from short duration to continuous duration (>12 hours) over 8 weeks. METHODS: The implementation phase was conducted during January 2021 and February 2021. All babies with birth weight <2 kg and who were haemodynamically stable were enrolled. QI (Qualitympovement) team included staff nurses, nursing in charge, resident doctors and consultants. Potential barriers were listed using fishbone analysis. Various possible interventions were identified and a priority matrix was formed to decide the sequence of introduction of changes. The following measures were subsequently tested by multiple PDSA (Plan Do Study Act) cycles: ensuring the availability of KMC charts, combining KMC chart with individualised weight chart, documentation of KMC duration in case sheets, increasing number of KMC chairs, opening of mother–neonatal ICU (M-NICU), KMC slings for mothers, education videos in local language and rewards for mothers. OUTCOME INDICATOR: Duration of KMC, recorded by bedside nurses on daily basis. RESULTS: A total of 86 newborns were enrolled. At the end of 8 weeks, average duration of KMC increased to 16.6 hours/baby/day. The intervention which was most useful in increasing KMC duration was opening of M-NICU. We were able to sustain the improvement at the end of 6 months. CONCLUSION: Sequential measures taken as a part of QI initiative, helped to increase the average duration of KMC from 4.6 hours/day to 16.6 hours/day, without much additional resources.