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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 %