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Table 3 QI projects and tested change ideas during ABC Intervention, N = 7 hospitals

From: Quality improvement strategies to improve inpatient management of small and sick newborns across All Babies Count supported hospitals in rural Rwanda

Area of improvement n (%) Change ideas tested n %
Medical equipment and supplies 2 (28.6 %) Prevent stockout of medicines (such as aminophylline) 1 14.3 %
Avail sheets for covering babies 1 14.3 %
Monitor emergency ambulance kit (medicines) and ensure its completeness for newborns and maternity cases 1 14.3 %
Avail Personal Protective Equipment (shoes and gowns) for infection prevention and control in NCU 1 14.3 %
Capacity building for NCU staff 5 (85.7 %) Training of NCU staff on clinical care in neonatal units according to NCU protocol 5 71.4 %
Training staff on how to use equipment in the NCU 2 28.6 %
Training of staff on infection prevention and controll for neonatal units 1 14.3 %
Training on managing infants with feeding difficulties 2 28.6 %
Sensitize on close monitoring of newborns 1 14.3 %
Improve monitoring in NCU 1 14.3 %
Documentation 1 (14.3 %) Proper documentation of fluids electrolytes and nutritional adjustments by medical doctors and nurses 1 14.3 %
Caregiver Engagement in Newborn Care 3 (42.9 %) Involve caregivers in care using danger signs tracking sheet 1 14.3 %
Use an “Expert Mom” role model to provide support to other mothers for breastfeeding, KMC, nad observing for danger signs 1 14.3 %
Task shifting to mothers for hypothermia monitoring by hand with alerts to nurses for temperature taking 1 14.3 %
Task shifting to mothers for ensuring on-time feeding newborns in NCU after 3 days support by NCU staff 1 14.3 %
Caregiver/client Social Support 1 (14.3 %) Provide porridge to moms in the NCU 1 14.3 %
Behavior Change Communication (BCC) 5 (85.7 %) Health education to mothers of babies admitted in NCU on nutrition, breastfeeding, feeding, prevention of hypothermia, danger signs, KMC, hygiene, etc. 4 57.1 %
Visual reminders on clocks/watches for feeding newborns 1 14.3 %
Process monitoring 2 (28.6 %) Routine check of vital sign completion 1 14.3 %
Conduct preterm death audit 1 14.3 %
Protocol Adherence 7 (100 %) Regular monitoring of vital signs several times per day 5 71.4 %
Adherence to protocol with regards to neonatal feeding and nutritional adjustment 3 42.9 %
Daily accurate weight measurement 2 28.6 %
Check-up for glycemia and temperature (for preterm babies) within 30 min of admission to the NCU 1 14.3 %
Regular monitoring of newborn weight gain 1 14.3 %
Monitoring of feeding practices 2 28.6 %
Change IV lines every 3 days 1 14.3 %
Staffing 2 (28.6 %) Have the same medical doctor rounding in NCU for 3 consecutive days per week 2 28.6 %
Increase staff assigned to work in NCU 1 14.3 %
Appoint permanent staff to NCU (Separating NCU from Maternity) 1 14.3 %
Interfacility Communication 1 (14.3 %) Health Center communicates the case to hospital NCU by phone call prior to reference of a neonate 1 14.3 %
Teamwork 4 (57.1 %) QI Team meeting to track the progress of the project 4 57.1 %
Joint meeting with maternity staff to discuss care of preterm newborns 2 28.6 %
Infection Prevention and Control 2 (28.6 %) Improve handwashing 1 14.3 %
Use of alcohol while on ward rounds for everyone 1 14.3 %
Regular staff deep cleaning of the NCU through “Umuganda” 1 14.3 %
Hygiene of incubators 1 14.3 %
Infrastructure Improvement 2 (28.6 %) Relocating NCU to larger existing spaces for improved flow of care 2 29 %