Implementing Essential Newborn Care

7/23/2019 Implementing Essential Newborn Care

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Essential Newborn Care

INTRODUCTON AND OUTLINE 5

STEP 1: SET UP A TEAM 8

LEADERSHIPFORTHE PROCESSANDPLANNING 8

COREGROUPFORIMPLEMENTATION 9

DEELOPINGAISIONFORNE!"ORNCARE 9

ADOCAC#FORACTION $%

STEP 2: ASSESS THE SITUATION 11

ADAPTINGNORMS ANDSTANDARDS $$

DEELOPTOOLSANDA PROGRAMMETOASSESSTHESITUATION $&

COMPILETHE DATAANDUNDERTA'EADOCAC# $(

STEP 3: DEVELOP AN ACTION PLAN 16

DETERMINE#OUROERALLAIM $)

SETPRIORITIESANDDEELOP APHASEDACTIONPLAN $)

STEP 4 IMPLEMENT ACTION PLAN 19

1. SYSTEMSTRENGTHENING 20

COMMUNIT#ADOCAC# &%

!ARDSETUPANDPROCESSES &%

STAFFAAILA"ILIT#*ROTATION &$

E+UIPMENT &$

TRANSFERANDREFERRAL &&

SUPPORTSERICES &&

2. STRENGTHENSKILLSTOIMPLEMENTSTANDARDGUIDELINESANDPROTOCOLS 22

&,$ REIE!E-ISTINGGUIDELINESANDSTANDINGORDERS!ITH'E#USERS &&

&,&,ASSESS'E#"ARRIERSTOIMPLEMENTATIONOFSTANDARDCARE &&

&,. ASSESSTRAININGNEEDS &.

&,/ IMPLEMENTTRAINING &)

HELPING"A"IES"REATH0H""1 &2

LINCTRAINING &8

$ $


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PERINATALEDUCATIONPROGRAMME0PEP1 .%

NEONATALE-PERIENTIALLEARNING .$

NE!"ORNICUTRAINING .$

IMPLEMENTPRE3SERICETRAINING .$

CLINICAL MENTORING .$

3. MONITORINGANDAUDIT 31

SUPPORTIESUPERISION .&

CLINICALAUDITAND+UALIT#OFPATIENTCARE .&

PERINATALANDNEONATALMORTALIT#ANDPERINATALREIE!MEETINGS ..

A"OUTPPIP FROM0!!!,PPIP,CO,4A1 ..

NEONATALMOR"IDIT#ANDSERICES ./

STEP 5 TRACK PROGRESS AND UNDERTAKE ACCREDITATION ASSESSMENTS 35

PROCESSINDICATORS .2

OUTPUTINDICATORS .2

OUTCOMEINDICATORS .2

IMPACTINDICATORS .8

ACCREDITATION 39

& &


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INTRODUCTON AND OUTLINE

I56ro7in newborn are in :o;r istrit an> 6ro7ine= re?;ires @ane aents an> lea>ers

w@o @a7e t@e 7ision= >e>iation an> >eter5ination to n;rt;re t@e i56le5entation o< essential

newborn are, T@e o55it5ent o< 5anae5ent is a e: 6;r6ose o< intro>;in essential newborn are is to ens;re t@at t@ere are o56etent

5aternal an> neonatal @ealt@ are 6ro7i>ers w@o are able to 6ro7i>e a66ro6riate newborn are

ser7ies in a well3esire> ser7ie @as been >e7elo6e> t@e sit;ation assess5ent will @el6 to

i>entis to be >one, I>entio NO! w@ilst

6lannin an> 5obilisin reso;res i;5 an> lon ter5 inter7entions,

Fi7e ste6s to a@ie7in essential newborn are are o;tline> below toet@er wit@ s;estions ot@ers w@o @a7e been worin to i56ro7e newborn are, !eeno;rae :o; to a>a6t t@e tools an> i>eas 6ro7i>e> or >e7elo6 :o;r own an> start i56ro7in

newborn are, !e tr;st o;r e6eriene will be ;se ;n>ertae are>itation assess5ents

. .


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LEVEL OIMPLEMENTATION

S!"#$% &'(!$!)* D!+),!()$%-%$

P,-!"(!'$ $%-%$'"/ '-%

Ste6 $ Set ;6 a tea5

Lea>ers@i6 6lannin

Foal 6erson= to

wor wit@ a 5e>ialor n;rsin5anae5ent to lea>t@e 6roess an>6lannin

Distrit *

reional6ae>iatriian in6lae to 6ro7i>elea>ers@i6

Pro7ine to a66oint a

lea> 6ae>iatriian an>neonatal n;rse to lea>t@e 6roess

Core ro;6 linial5anaer=res6onsible5aternit: an>6ae>iatri >otorsan> n;rses

Reional6ae>iatriianan> neonataln;rse to worwit@ >istrit5anaers toeternal e6erts to lea>t@e 6roess, A66oint atea5 o< assessors an>are>itors

De7elo6in a7ision eas= 7isitin ot@ersites

Distrit to

>e7elo6 as@are> 7ision=b: wors@o6s=7isits=ben@5arin

De7elo6 a s@are> 7ision

b: listenin to all=7isitin= ben@5arin

A>7oa: 7oate to allrele7ant role6la:ers 7oate to @ea> o7oate @;5an reso;res

Ste6 & Assess t@e sit;ation

A>a6tinnor5s an>

stan>ar>s

Re7iew a7ailable national an> 6ro7inial nor5s an> stan>ar>s an>re7ise t@e5 base> on 7ision 6roess toassess t@esit;ation

Tool at@o5e= L"! rates=a>5ission= >eat@san> a;se o< >eat@

For >istrit an> 6ro7ine re7iew birt@s=L"! rate= a>5issions= >eat@s= a;se oeat@ to @a7e baseline o< sit;ation an>

6riorit: areas s5all newborns

Assess all ser7ies an> e?;i65ent at ea@ >istrit an> 6ro7inialsta

Assess stan=rotation an>o56etenies

Assess an> o56are stan at 6ae>iatriians re?;ire>, Assess 6re3

ser7ie neonatal trainin an> a>7ane>

/ /


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>e7elo65ent neonatal trainin

Assess t@e?;alit: o< are

6ro7i>e>

Do a are a;>itbase> on stan>ar>

;i>elines

Arrane a reor> re7iew or areassess5ent on e: on>itions on a sa56le

o< reor>s

Co56ile t@e>ata an>;n>ertaea>7oa:

Co56ile t@e >ata atea@ ste6 an>;n>ertae a>7oa: >eter5ine >ata an>;n>ertae a>7oa: >e7elo6 a6@ase> ation6lan

De7elo6 an ation6lan 6rioritiseati7ities toi55e>iate ations=5e>i;5 an> lonter5 ation,

Set ;6 6riorities= an>6;t in 6laei55e>iate ations=an> t@en a 6lan i;5 an> lonter5 wor

Deter5ine6riorities an>ens;re s;66ort in set ;6 an>6roesses

Re3arrane war>san> s

De7elo6 6ro7inial reor>s= set ;66ro7inial stan>ar>s ar>


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I56le5enttrainin ie>

Start wit@ H"" an>in3ser7ie trainin

De7elo6 6ro7inial an> >istrit trainina6ait: o< in3ser7ie an> 6re3ser7ie

trainin

Clinials;6er7ision an>a;>it

Co55enes;6er7ision

De7elo6 s;6er7ision an> a;>it tools

On siteiatriian to 7isit>istrit istrittea5s

Ste6 ( Tra 6roress an> ;n>ertae are>itation assess5ents

In6;ts H;5an an>Bnanial reso;res

Distrit tea5 in6lae

N;5ber o< >istrittea5s= reionalan> tertiar: @;5anreso;res

Proess A>7oa:Ation 6lans

Ation PlansTea5s in 6laeisits to s

i>entiBe>

E?;i65ent nee>sTrans6ort nee>sTrainin nee>s

O;t6;ts Nor5s an>stan>ar>sG;i>elinesTools ;se>N;5ber o< @ealt@worers traine>

Nor5s an>stan>ar>sTrainins on>;te>Retrans6ort 6oliiesNeonatal a5b;lanein 6lae

Pro7inial ob ai>s

O;to5e Failities are>ite> an>stae>

+;alit: o< traininNo o< ite>Reitation

I56atNeonatal 5ortalit:ratesPerinatal 5ortalit:ratesA>5issions6erentaes an>ase 5issions6erentaes an>ase 5issions6erentaes an>ase istrit an> ea@


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Lea>ers@i6 6lannin

Foal 6erson to worwit@ 5e>ial an>n;rsin5anae5ent an> tolea> t@e 6roess an>6lannin

Distrit *reional6ae>iatriian in6lae to 6ro7i>elea>ers@i6

Pro7ine to a66oint alea> 6ae>iatriian an>neonatal n;rse to lea>t@e 6roess

Core ro;6 linial5anaer=res6onsible5aternit: an>6ae>iatri >otorsan> n;rses

Reional6ae>iatriianan> neonataln;rse to worwit@ >istrit5anaers toistritle7el

De7elo6 a ore ro;6 oiatriians= neonataln;rses= 5anaers an>eternal e6erts to lea>t@e 6roess, A66oint atea5 o< assessors an>are>itors

De7elo6in a7ision e>b: s@arin i>eas=7isitin ot@er sites

Distrit to>e7elo6 as@are> 7ision=b: wors@o6s=7isits=

ben@5arin

De7elo6 a s@are> 7isionb: listenin to all=7isitin= ben@5arin

A>7oa: er ro;6 int@e 7oate t@enee> 7oate to @ea> o7oate @;5an reso;res

LEADERSHIP FOR THE PROCESS AND PLANNING

Healt@ s:ste5s are o56le an> t@ere are instit;tional ;lt;resJ as well as in>i7i>;al ;lt;res an>

barriers to na7iate ;ntil t@e instit;tion a>o6ts a ;lt;re o< @ane, A ;lt;re o< @ane eists

w@en t@e e: 6la:ers in t@e en7iron5ent are o6en to new 6ossibilities to i56ro7e 6atient are,

Peo6le bein to t@in 5ore reati7el: abo;t a66arent ins;r5o;ntable barriers, 0JA ;lt;re is t@e

attit;>e an> be@a7io;r t@at are @arateristi o< a 6arti;lar ro;6 or oranisation,1

On site e t@e neessar: lea>ers@i6 an> te@nial

e6ertise to >istrit @os6itals t@at >o not ;s;all: @a7e s6eialists or s6eialist n;rses on t@eir sta

establis@5ent, T@ese i>eall: be 5e5bers o< a >istrit s6eialist tea5= w@o are

@osen to be t@e >ri7ers o< @ane, In a>>ition to te@nial e6ertise in neonatal linial are an>

@ealt@ s:ste5 >e7elo65ent t@e: 5;st s@ow lea>ers@i6 sills, T@e @el6 t@e tea5 to atte56t to 5eet t@e ti5e lines, !@en 6roress is slow an>

es6on>en: t@reaten to set in t@e eall: t@e i>entii7i>;al in 5anae5ent 0t@e CEO or linial 5anaer= or

n;rsin 5anaer1 in 5aternit: an> in t@e neonatal ;nit inl;>in a >otor w@o will s@are t@isres6onsibilit: i7i>;als 5a: be ter5e> site lea>ers,

Failitators s@o;l> also be 5entors, Trainin= 6oliies= ;i>elines an> ation 6lans alone >ont

a>>ress t@e 5an: @allenes t@at are assoiate> wit@ i56ro7e5ent an> @ane in ser7ie3

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Essential Newborn Care>eli7er:, I56le5entin Essential Newborn Care re?;ires a lon3ter5 o55it5ent an> onoin

s;66ort t@ro;@ a>7ie= s@are> res6onsibilit:= olleti7e ao;ntabilit: an> a>7oa: wit@ an> ;in an> 6ro7i>in it,

Lea>ers@i6 5a: be 6ro7i>e> b: an in>i7i>;al or a s5all tea5, T@e lea>ers@i6 5;st @a7e re>ibilit:

in ter5s o< te@nial e6ertise in t@e area o< essential neonatal are, For t@is reason t@e lea>ers@i6will ;s;all: be or inl;>e a liniian wit@ e6eriene an> interest in t@is Bel>,

A 6ro7inial 6ae>iatriian or an: @ealt@worer wit@ te@nial e6ertise in newborn are an> @ealt@

s:ste5s i56ro7e5ent is well 6lae> to lea> t@e i56ro7e5ent 6roess, It is 7er: i56ortant t@at

t@e: reei7e s;66ort an> bain istrit s6eialist tea5= inl;>in t@e 6ae>iatriian an> 6ae>iatri an> neonatal n;rse an

6ro7i>e lea>ers@i6 in t@e >istrit, T@e: will wor wit@ ea@ @os6ital to i56ro7e are at er is to i>entiistrit an> e t@e >iretor or Manaer o< Maternal an> C@il> Healt@= a

6ae>iatriian or neonatoloist reional @os6itals an> neonatal

n;rses, I< :o; >o not @a7e t@e re?;ire> e6ertise= loo o;tsi>e :o;r 6ro7ine or >istrit iatriians an> neonatal n;rses to assist on a 6art ti5e basis, T@e i56le5entation re?;ires

assess5ent= onoin s;66ort= trainin an> are>itation, A rees

eter5al 5e5bers w@o an >o t@e assess5ent an> are>itation are ;seistrit inl;>es t@e >istrit 5aternal an> @il> @ealt@ tea5= MC!H= an>

6ae>iatriian an> neonatal n;rses istrit,

At @os6itals t@e ore ro;6 5a: inl;>e t@e linial an> n;rsin 5anaers= a >otor an>

6ro


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Essential Newborn Care;nits= an> e6lore w@at t@e: wo;l> lie t@eir ser7ies to loo lie, T@ere 5a: be >ierent

6ere6tions o< w@at newborn are is an> s@o;l> be in a 6arti;lar area, In r;ral @os6itals sta in

t@e >istrit 5a: not @a7e seen a Neonatal ICU or a 'anaroo 5ot@er are ;nit,

ADOCAC# FOR ACTION

S@are :o;r 7ision er to 5obilise

reso;es 7oa: 5aterial

), "reast in a>7oa: 5aterial

T@ese reso;res are loate> in t@e A66en>i an> CDROM ;n>er RESOURCES FOR ADOCAC#

9 9


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$% $%


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STEP 2: ASSESS THE SITUATION

S)% 2: A++%++ )% +!)')!"

A>a6tin

nor5s an>stan>ar>s

Re7iew a7ailable national an> 6ro7inial nor5s an> stan>ar>s an>re7ise t@e5 base> on 7ision a6rora55e toassess t@esit;ation

Tool at@o5e= L"! rates=a>5ission= >eat@san> a;se o< >eat@

For >istrit an> 6ro7ine re7iew birt@s=L"! rate= a>5issions= >eat@s an> a;se oeat@ to @a7e baseline o< sit;ation an>6riorit: areas

s5all newborns

Assess all ser7ies an>

e?;i65ent at ea@ >istrit an> 6ro7inialsta>e7elo65ent6rora55e

Assess stan=rotation an>o56etenies

Assess an> o56are stan at

n;rses an> 6ae>iatriians to s;66ortneonatal i56ro7e5ent an> trainin,

Assess 6re3ser7ie neonatal trainin an>a>7ane> neonatal trainin

Assess t@e?;alit: o< are

6ro7i>e>

Do a are a;>itbase> on stan>ar>;i>elines

Arrane a reor> re7iew or areassess5ent o< t@e 5anae5ent o< e:

on>itions s

Co56ile t@e>ata an>;n>ertaea>7oa:

Co56ile t@e >ata atea@ ste6 an>;n>ertae a>7oa: >eter5ine >ata an>;n>ertae a>7oa: in>iators o< newborn are in t@e 6ro7ine= in ea@ >istrit an>

wit@ t@e aree> 7ision stan>ar>s are o;tline> in C@a6ter &, T@ese 5a: be a>a6te> to alin wit@ t@e 7ision

istrit an> stan>ar>s t@at @a7e been a>o6te> will be

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Essential Newborn Care;se> to 5eas;re t@e ;rrent ser7ie an> 6lan t@e stan>ar>s s@o;l>

be re7iewe> an> a>a6te> as t@e newborn are ser7ie >e7elo6s,

When Limpopo started planning services the num"er of tertiary and

secondary "eds re#uired seemed un"elieva"ly high, "ut as the district

hospitals have developed their services and "eds there has "een an

increasing recognition of "a"ies in need of level II and III care to the point

that level II and III resources have "een overwhelmed.

DEELOP TOOLS AND A PROGRAMME TO ASSESS THE SITUATION

T@e LINC tea5 it ;see b: enti >raw

;6 an ation 6lan, T@e LINC tea5 t@en on>;te> a 5ore >etaile> assess5ent, T@is 6ro7i>e> a

5ore s6eiB seon> assess5ent t@at o;l> be ;se> to o56are newborn ser7ies at >ierent

a6tation an> ;se, 0A66en>i $1

T@ere are a n;5ero;s ele5ents to a >etaile> assess5ent, An assess5ent 5a: tae 5ore t@an a

>a: to o56lete an> it 5a: be neessar: to 7isit a l: to o56lete an assess5ent,

An assess5ent tool istrits an> 6ro7ine s;55arises in 6ro7inial 6lannin, 0A66en>i &1

CURRENT STATUS OF "IRTHS= L"!= ADMISSIONS AND DEATHS

T@e an> o56are> wit@ t@e a>a6te> nor5s an>

stan>ar>s

T@e n;5ber o< >eli7eries in t@e @os6ital*s= linis in t@e at@5ent area, T@e n;5ber o ot@er @o5e birt@s t@at @a7e been reor>e> at t@ese

t@eir >istrib;tion b: wei@t ban>s 0e, $%%%

3$/99 ra5s1,

T@e n;5ber o< babies a>5itte> to t@e neonatal ;nit,

T@e reasons 5ission to t@e neonatal ;nit, Are t@ese a66ro6riate in>iations Are

so5e a7oi>able

T@e n;5ber o< stillbirt@s an> t@e n;5ber o< earl: an> late neonatal >eat@s,

T@e a;ses o< t@e stillbirt@s an> neonatal >eat@s,

$& $&


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T@e birt@wei@t o< t@e babies t@at >ie>,

T@e 6lae o< >eat@,

T@e ata

C@e t@at t@e >ata on PIP an> DHIS @a7e been a;ratel: reor>e> an> are onr;o;s

Maternit: reor>s 5a: be ;se> to ross@e t@is >ata

T@e neonatal a>5ission boo

T@e 6ae>iatri a>5ission boo, !ere an: neonates 0&8 >a:s1 a>5itte> to t@e 6ae>iatri

war> I< so w@at was t@e reason 5ission an> t@e o;to5e o< t@e a>5ission

ASSESS THE SERICES AND FACILITIES

T@e ser7ies an> in,

A) &'(!$!)* $%-%$

Assess t@e ro;tine are,

Rea>iness o< labo;r war> an> t@eatre a>7ane> neonatal res;sitation

"abies are e6t sin to sin wit@ t@eir 5ot@er an> breast in initiate> wit@in .%

5in;tes,

!ell babies roo5 in wit@ t@eir 5ot@ers an> reei7e an> s;66ort is 6ro7i>e> e> an> >o;5ente> in t@e 5aternit: are @art an> roa>

to @ealt@ boolet

PMTCT is 6ro7i>e> to t@e 5ot@er an> bab:,

!@en 5e>iall: in>iate> >isretel: a>5inistere>,

T@e neonatal ;nit ser7ie an> t@e e?;i65ent s@o;l> be assesse>,

$. $.


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T@e nor5s are 6ro7i>e>, Assess w@et@er t@e ser7ies an> in 5e>ial air in t@e neonatal ;nit For ;nits t@at 6ro7i>e or will 6ro7i>e

CPAP t@e o:en an> 5e>ial air so;res 5;st be able to 6ro7i>e t@e re?;ire> 6ress;re e7ie,

Assess t@e are 6ro7i>e> in t@e neonatal ;nit, A linial a;>it reor> re7iew are

6art o< t@e assess5ent tool,

T@e (,%%"+!-% &'(!$!)* +!)')!" '++%++%") )$ will ;i>e t@is 6roess,

A) ,-!"(!'$ $%-%$

Collate t@e in e?;atel: a>>resse> in t@e 6lans Do t@e:

5eet t@e aree> nor5s an> stan>ar>s

Assess t@e tertiar: an> reional neonatal ser7ies, Are t@ere eno;@ be>s an> oo> are,

Assess t@e neonatal trans trans6ort in t@e 6ro7ine,

T@e 6ro7inial"%," '++%++%") )$ an be a>a6te>


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!@o is res6onsible es te@nial assistane

T%,)!',* '"/ R%#!"'$ (',%

How 5an: neonatoloists are t@ere

How 5an: 6ae>iatriians

How 5an: neonatal n;rses

!@at is t@e 6lan to attrat an> retain 6ae>iatriians an> neonatoloists

!@at is t@e 6lan to train neonatal n;rses

!@at trainin taes 6lae in t@e 6ro7ine

Is t@is s;ient s o< t@e 6ro7ine

ASSESS THE +UALIT# OF CARE PROIDED

Assess w@at ;i>elines an> 6oliies are in 6lae to 5anae newborns at in t@e

6ro7ine,

I" )% ,-!"(%:

!@at ;i>elines are in 6lae e7elo6in 6ro7inial ;i>elines base> on t@e National

stan>ar> treat5ent ;i>elines

Are 6oliies in 6lae er 5ot@er


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Are t@e neonatal ;i>elines in 6lae

Are t@e: ;6 to >ate an> ;se>

Con>;t a linial a;>it o< t@e i56le5entation o< t@e ;i>elines, T@e linial a;>it tool is 6art o to >eter5ine i< ;i>elines are bein , A 6ersonon7ersant wit@ t@e stan>ar> linial ;i>elines s@o;l> on>;t t@e a;>it,

T@e LINC tea5 @as >e7elo6e> a reor> a;>it to assess t@e ?;alit: o< linial are, For ea@ 5aor

linial on>ition t@ere is an assess5ent w@i@ i7es a sore e> aainst t@e

stan>ar> are re?;ire> ition, A sore o< 8%Q is rear>e> as oo> are= )% 8%Q

ae6table are= an> )%Q ;nae6table are, T@e 6erson on>;tin t@e assess5ent s@o;l> be

on7ersant wit@ t@e stan>ar> are an> wo;l> ;s;all: be a 6ae>iatriian or e6eriene> >otor or

neonatal n;rse, T@ese tools are atta@e>, Tea5s are eno;rae> to learn is;ssion abo;t a ontentio;s newborn are to6i

In7ite an o;tsi>e s6eaer to tal abo;t an as6et o< newborn are

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STEP 3: DEVELOP AN ACTION PLAN

S)%+ 3: D%-%$ '" '()!" $'"

Deter5ine :o;r

oal e7elo6 a6@ase> ation6lan

De7elo6 an ation6lan 6rioritiseati7ities iate ation=5e>i;5 an> lonter5 ation,

Set ;6 6riorities= an>6;t in 6laei55e>iateinter7entions= t@en6lan i;5 an>lon3ter5 ati7ities,

Deter5ine6riorities an>ens;re s;66ort in5issions to neonatal;nit

$%Q $(Q $(Q

For reional @os6ital Qa>5issions istrit @os6itals Qtrans


18/47

Essential Newborn CareI>enti

res6onses to ea@ iss;e into i55e>iate= 5e>i;5 an> lon3ter5 inter7entions, Iss;es t@at 5a:

nee> inter7entions inl;>e

A>7oa:

Protools an> 6oliies

Labo;r war> res;sitation

Postnatal war> are

Me>ial Stan

N;rsin Stan

Sta >e7elo65ent

Neonatal ;nit s;66lies

Iniate= 5e>i;5 an> lon3ter5 inter7entions er ;sin t@e


19/47

Essential Newborn CareAt e i55e>iatel: an> >o not re?;ire siniBant

a>>itional reso;res, For ea56le ;n>er e?;ate s6ae,

Rearranin t@e n;rser: la:o;t an> re5o7in ;nneessar: e?;i65ent 5a: @el6,

!@ile waitin elines 5a: be te56oraril: a>a6te>,

"elow is an ea56le o< an initial ation 6lan istrit @os6ital,

Proble5 Ati7it:re?;ire>

Ste6s to be

Person*sres6onsible

Ti5eline

Newreso;resre?;ire>

1. Lack ofinformationabout neonatalcare incommunity andhospital

Advoacy meetingwith maternity staff,doctors andmanagement

Advocacy meetingwith clinic nursesand IMCI CCgroups

!lan meetings withmanagement

".# 1 month Catering forcommunitymeeting

$. Inade%uatenumbers ofprofessionalnurses

"eed dedicated staff$AM& ' ( !rof."urses

)*iscussrescheduling ofallocation)*raw trainingschedule + presentit to supervisor

. "Matron M

-. M. "

August

. Lack ofpolicies onreferral

*evelop referralpolicy to and fromclinics and toregional hospital

)*iscuss with unitmanager)Meet with regionalhospital)Meet with !C)*raw up policy)Meet with all role

players toimplement plociy

. " /uly "one

. !rotocols 0et appropriatewritten policies.*istribution +

)*iscuss with unitManager)Meeting with all

".

". /

LI"C charts#tandardtreatment

$9 $9


20/47


implementation ofpolicies

staff nurses +doctors .)*iscussion +formulation ofprotocols)!roper filing of

protocols

guidelines!! manual"otes onnewborn care

An ea56le o< a blan ation 6lan is 6art o< t@e Sit;ation Assess5ent tool

A) ,-!"(!'$ $%-%$set 6riorities an> set tarets iate= 5e>i;5 an> lon3ter5 ati7ities

$, For Pro7inial oor>ination an> s;66ort

&, For Pro7inial 6oliies an> 6rotools

., For Pro7inial tools an> ob ai>s

/, For Tertiar: ser7ies

(, For >e7elo65ent o< Reional ser7ies

), For trainin

2, For e?;i65ent an> s;66lies

8, For are>itation an> 5onitorin

STEP 4 IMPLEMENT ACTION PLAN

S)%+ 4: I$%%") '()!" $'"

$, S:ste5 strent@enin

!ar> set ;6 an>6roesses

Re3arrane war>san> s

De7elo6 6ro7inial reor>s= set ;66ro7inial stan>ar>s ar>


21/47


Retrans6ort

Strent@en trans6ort ;i>elines an> 6rotools

Re7iew

;i>elines

Re7iew 6ro7inial

;i>elines an>stan>in or>ers si bab: are

Assess e:barriers to

i56le5entation

Assess e: barriersto i56le5entation

Assess barriers toi56le5entation

Tea5 s

Assessnee>s

Assess 6ro7inial trainin nee>s= an>i>entiin3ser7ie trainin

De7elo6 6ro7inial an> >istrit trainina6ait: o< in3ser7ie an> 6re3ser7ietrainin

Clinials;6er7ision an>

a;>it

Co55enes;6er7ision

De7elo6 s;6er7ision an> a;>it tools

On siteiatriian to 7isit>istrit istrittea5s

I56le5entation 5;st be a66roa@e> wit@ t@e ;n>erstan>in t@at i56ro7e5ent o< a ser7ie is a

ontin;o;s 6roess t@at 5;st ontin;e


22/47

Essential Newborn Cares6ae= li@tin= worKow an> 6@:sioloial nee>s o< t@e sta, T@e e?;i65ent s@o;l> be 6ro6erl:

5aintaine> an> a>@ere to t@e aree> stan>ar>s, Stan s@o;l> be a>e?;ate an> t@ere s@o;l> be

an a66ro6riate a5b;lane ser7ie in s;66ort,

In a>>ition it is i56ortant t@at e7er: newborn in t@e ser7ie area s@o;l> be able to aess t@e

rane o< ser7ies a7ailable, T@is entails 6lannin eli7eries not onl: t@ose t@at o;r at e>, I< t@e eistin war> >oes not 5eet t@e

reo55en>e> stan>ar>s onsi>er inno7ations t@at i56ro7e eien: w@ile 5oti7atin or alterations, Can t@e in;bators be re3arrane>= or t@e n;rsin station re36ositione> Are

t@ere 6roble5s wit@ ine at

5ini5al ost Is t@ere an alternati7e s6ae w@ere e?;i65ent 5a: be store> w@en it is not in ;se

INPATIENT NE!"ORN UNIT

P,-!"(!'$ $%-%$: Set ;6 6ro7inial stan>ar>s entis an> tools re?;ire> in t@e 6ro7ine= 5ission boo= newborn

reor>s an> obser7ation @arts= >is@are an> transs ot@er 6ro7ines, T@ese 5a: be ;se> to assist wit@ t@e >e7elo65ent os,

A) &'(!$!)* $%-%$a>o6t stan>ar>s an> ens;re t@at t@ere are a66ro6riate >ail: ro;tines in t@e

neonatal war>, T@e 6ro7inial newborn a>5ission boo= newborn 6atient reor>= obser7ation

@arts an> stan>ar> ;i>elines be a7ailable in t@e


23/47


'MC UNIT

Establis@ stan>ar>s 5ae it as @o5el: as 6ossible, Rer;it @el6 to 5ae >;7et o7ers,

Re?;est rea>in 5aterials= 5oti7ate olls= anot@er >;7et o7ers,

T@is ee6s t@e 5ot@ers an> sta o;6ie> an> 5oti7ate>,

AT THE TIME OF "IRTH

T@e labo;r war> 5;st be a>e?;atel: 6re6are> to reei7e t@e bab:, T@is inl;>es 6ro7i>in r: s;r an a>7ane> res;sitation trolle: s@o;l> be on site or nearb:, S;tion= o:enan> a ba= 7al7e= 5as >e7ie s@o;l> be on3@an> an> re;larl: @ee>= 6re .% 5in;tes= i< 6ossible= will

6ro5ote a;rate 5onitorin o< t@e newborn bab:,

T@ere s@o;l> be a66ro6riate ob ai>s to s;66ort are at birt@ s;@ as basi neonatal res;sitation

@arts= a6ar @art= @an>3was@in @arts an> breastin @arts,

ROUTINE CARE IN POSTNATAL !ARD OR !ELL "A"# CARE

Most babies roo5 in wit@ t@eir 5ot@ers in t@e 6ostnatal war>, T@e: re?;ire 5onitorin an> are as

>oes t@e 5ot@er, I< nee>e> 5ae @anes to t@e 6ostnatal war> to ao55o>ate t@e bab: wit@t@e 5ot@er, Re7iew t@e 6oli:= 6raties an> 6roe>;res, Co55;nal bat@in an> 6raties t@at

ee6 babies se6arate be sto66e>, "esi>es t@e beneBts to t@e 5ot@er

an> bab:= t@is will be atten>e> to toet@er wit@ t@e 5ot@er,

Hel6 t@e 5ot@er to establis@ breastin= to reonise t@at t@e bab: is well an> to i>enti


24/47


E+UIPMENT

E?;i65ent nor5s an> stan>ar>s= an> s6eiBations are atta@e>, Ens;re t@at t@ere is an

e?;i65ent boo in t@e neonatal ;nit to ee6 tra o< all e?;i65ent 6;r@ase> an> @ow it is


25/47


Most tertiar: @os6itals @a7e t@eir own ;i>elines elines

&,&,ASSESS 'E# "ARRIERS TO IMPLEMENTATION OF STANDARD CARE

T@e e: barriers to t@e i56le5entation o< ;i>elines s@o;l> be assesse> be7oa: wors@o6s an> sit;ation assess5ent will @a7e i>entiBe> a n;5ber oeter5ine t@e barriers an> o66ort;nities in t@e neonatal ;nit, So5e @os6itals rotate sta

i;lt = to learn ;i>elines an> 6oliies,

Maternal an> newborn are beneBts w@en sta are 6er5anentl: 6lae> in t@e 5aternit: orneonatal ;nit, St;>ents an> new sta 5a: rotate t@ro;@ t@e ;nit, T@is is an o66ort;nit: to

instit;tionalise oo> 6ratie,

La o< a7ailabilit: o< ;i>elines, G;i>elines not >is6la:e> or a7ailable in as;alt:=

5aternit: an> neonatal ;nit,

&( &(


26/47


La o< b;: in to t@e 6rotools, E7en w@en ;sin 6ro7inial or national 6rotools t@ese

s@o;l> be >is;sse> wit@ all t@e sta, E6lain t@e rationale elines an> w@ere

neessar: >raw ;6 an a>a6te> loal 6rotool t@at will assist wit@ i56le5entation o< t@e

;i>elines

G;i>elines 5a: not be o55;niate> to all >otors= inl;>in sessional an> new >otors,So5e >otors onl: loo a are not aware o< t@e

;i>elines, In s5all @os6itals= stan>in or>ers e?;ate sta= e?;i65ent an> not beo5e an

absol;te barrier to i56le5entation,

T@e la o< ontin;o;s on3site s;66ort to 6ro5ote t@e i56le5entation o< a new ;i>eline

an allow a re7ersion to ol> 6ratises, T@is is 6arti;larl: t@e ase w@en t@e ol> 6ratise is

entren@e> in t@e instit;tional ;lt;re,

&,. ASSESS TRAINING NEEDS

Ens;rin t@at >otors an> n;rses @a7e t@e o56etenies to 6ro7i>e essential newborn are an be

a>>resse> t@ro;@ t@e trainin o< 5oti7ate> 6er5anent sta, Newborn are o56eten:

re?;ire5ents s@o;l> Brst be e7al;ate>, * competency is a "lend of skills, a"ilities, and knowledge

needed to perform a speci+c task.

I>enti b: >ierent @ealt@ worers= an> 6lan trainin an> learnin to

ens;re t@at t@e: are 5et, A?;irin an> 5aintainin t@e o56eten: re?;ires t@e ;se o< >ierent

tea@in st:les an> rein

s;66ort s@o;l> 6arallel an: trainin 6rora55e,

"asi neonatal res;sitation is a ore o56eten: neonatal,Hel6in "abies "reat@e is reo55en>e> as a o;rse otors= a>7ane> 5i>wi7es an> neonatal n;rses s@o;l> atten> an a>7ane> neonatal

res;sitation o;rse,

T@e LINC @arts an> 7ario;s LINC trainin 6aaes were >e7elo6e> to a>>ress t@e o56etenies

re?;ire> to 6ro7i>e essential newborn are, T@ese are basi o56etenies t@e neonatal ;nit nee> to @a7e, T@ere are a>>itional

o56etenies t@at 5a: be nee>e> an> ot@er trainin 6aaes s;@ as t@e Perinatal E>;ation

Prora55e are alternati7es t@at an b;il> on t@e basi o56etenies,

At reional an> lare >istrit @os6itals t@at 6ro7i>e CPAP an> @i@ are= so5e o< t@e n;rses s@o;l>

@a7e trainin in neonatal intensi7e are, So5e tertiar: entres oer t@is as a $3:ear trainintrainin o;rse at inter7als,

Dotors in 6ae>iatri war>s are eno;rae> to obtain a Di6lo5a in C@il> Healt@, T@is will 6ro7i>e

7oational rowt@ an> i56ro7e t@e loal sills an> nowle>e in 6ae>iatri an> newborn are,

&) &)


27/47

Essential Newborn CareSo5e i56ortant trainin an> ;6>ates 5a: be a7ailable as s@ort o;rses or interate> into ot@ero;rses, For ea56le PMTCT

"reast in

EPI

Genetis

T@e list below i>entiBes t@e o56etenies a>>resse> b: t@e LINC trainin 6aae, It also lists t@e

o56etenies re?;ire> ierent ateories o< sta, A blan @art is inl;>e> in t@e a66en>i

an> ea@ to >raw ;6 a si5ilar list,

&2 &2


28/47


COMPETENCIES RE+UIRED IN NE!"ORN CARE

C%)%"(* S (%)%"(*

MO

P'%/!')

,!(MO

A/-'"(%

/5!&%

N%."')

'$PN

M!/85!&

%

N%

."')'$

9ENA

MSSN4./3$%

'"/$%

++."

O)%, ')%,!'$

Res;sitate t@enewborn at birt@

"asi res;sitation Hel6in "abies"reat@e

Pro7i>e A>7ane>res;sitation

NRPAPLSPALSSAMA*FM

Pro7i>e ro;tineare to newbornsat birt@

Pro7i>e ro;tine arean> triae in labo;rwar>

M%

Assess t@e newbornae ro;tine arein 6ostnatal war>

M% PEP

Dis@are an>5ae a s;66ortbreastin

M% IMCI=Latation5anae5ent

Assess an>lassi s5allnewborn

Assess an> Classi Classi 5anae@:6ol:ae5ia

M&=L2 PEP

Pro7i>e sa


29/47


Pro7i>e sae sa K;i>s to babies

M&=L8

PEP

Saistress

M&=L$$

PEP

Manae babies onCPAP

A>>itionalLessons

Manae low birt@wei@t babies

M&=L$&

PEP

Manae babies wit@in5anae neonatalene6@alo6at@:

M&=L$(

PEP

Pre7ent an>5anae neonatala;n>ie

M&=L$) PEP

Manae onenitalabnor5alities

M&=L$2

PEP=

Manae e6os;re toHI= Tb an> s:6@ilis

M&=L$8

PMTCT

Co;nsel 5ot@erto are rowt@ an> o;nselon in

M.=L$9L&%=L&$

IMCILatation5anae5ent

Co;nsel 5ot@er onare= w@en to ret;rn

M.=L&&

Ens;re a lean= sa l:newborn en7iron5ent

M&=L9

AbbreviationsPEP: Perinatal education ProgrammeIMCI: Integrated Management of Childhood IllnessPMTCT:NRP: Neonatal Resuscitation ProgrammeHBB: Heling Babies BreatheM!!N: Management of !ic" and !mall Ne#borns

&,/ IMPLEMENT TRAINING

!;este> trainin an> learnin ierent ateories o< @ealt@ worersDotors

Di6lo5a C@il> Healt@

& >a: LINC trainin o;rse

Mot@er an> In


30/47


PMTCT trainin an> ;6>ates

Sel< st;>: wit@ Neonatal PEP

Pro7ane> Mi>wi Ine> neonatal are, T@e sills learne> s@o;l> be rein t@ro;@ re;lar

;6>ates sessions or >rills at ea@ 5ortalit: b: a>>ressin one o< t@e 5ost i56ortant a;ses o< neonatal >eat@intra6art;53relate> e7ents 0birt@ as6@:ia1, H"" is an e7i>ene3base> e>;ational 6rora55et@at tea@es an eeti7e ste6wise a66roa@ inate> wit@ ot@er inter7entions in a 6aae

selete> to i56ro7e neonatal an> 5aternal @ealt@, H"" an be ;se> as t@e res;sitation

o56onent in o;rses tea@in Essential Newborn Care an> o;rses in 5i>wi at all le7els in t@e @ealt@ s:ste5, It enables t@e etension o< res;sitation trainin to Brst3

le7el @ealt@ @ealt@ worers in reso;re3li5ite> settins= w@ere t@ese sills are 5ost

lain, It also an be ;se> in @i@er3le7el @ealt@ in tertiar: oes not re6lae= o56re@ensi7e res;sitation 6rora5s s;@ as t@e Neonatal

Res;sitation Prora5 0NRP1, "ot@ H"" an> NRP tea@ t@e sa5e Brst ste6s in res;sitation= b;t

NRP also inl;>es t@e ;se o< s;66le5ental o:en= @est o56ressions= int;bation= an>

5e>iations,

.% .%


31/47

Essential Newborn CareH"" ;ses a learner3entere> e>;ational 5et@o>olo: wit@ e56@asis on 5aster: o< e: sills,

Pitorial= olor3o>e> 6rint 5aterials an> a low3ost= @i@3B>elit: neonatal si5;lator enae

learners an> e56ower t@e5 to ontin;e learnin in t@e wor6lae, H"" eno;raes s= si5;lators= an> 5anne?;ins a7ailable in t@e wor6lae to 5aintain sills,

As an interal ele5ent o< 5aternal an> neonatal are= H"" an at as a atal:st eri56ro7e5ents in t@ese ser7ies= 6arti;larl: at t@e 6eri6@er: o< t@e @ealt@ s:ste5,

F;rt@er a>7oa: an> ins= an> an i56le5entation

6aae are in t@e Reso;re setion an> CD ROM,

It is reo55en>e> t@at t@ere s@o;l> be & Hel6in "abies "reat@e istrit

@os6ital, T@ese in one >a: b: a 7ane> 5i>wi7es= an> senior >otors are traine> in a>7ane> neonatalres;sitation= an> 5aintain t@eir sill an> are>itation ite>

o;rses are oere> t@ro;@o;t t@e o;ntr: an> inl;>e t@e A5erian Aa>e5: o< Pae>iatris

o;rses t@e Neonatal Res;sitation Prora5 0NRP1= an> t@e "ritis@ Pae>iatri Assoiation Co;rse=

A>7ane> Pae>iatri Lies neonatal res;sitation, ESMOE E

inl;>es a 5o>;le on neonatal res;sitation,

ROUTINE CARE

All 5aternit: sta 6ro7i>e ro;tine are to newborns, T@is inl;>es i>enti 6ro7i>in ro;tine 6re7enti7e are, T@e are i7en is

>o;5ente> an> ine> to t@e 5ot@er, Ro;tine are inl;>es latation

5anae5ent an> PMTCT,

Trainin an be 6ro7i>e> as 6art o< in3ser7ie trainin or on an interate> $ . >a: trainin o;rse

t@at inor6orates all t@e as6ets o< are inl;>in H"",

A se6arate PMTCT an> latation 5anae5ent o;rse 5a: be oere> in t@e >istrit or 6ro7ine,

LINC 6ro7i>es @arts on ro;tine are o< newborns wit@ a learner 5o>;le an> trainin t@at an

ao56an: t@e @arts, Trainin 5a: be 6ro7i>e> as 6art o< a o;rse or as an in3ser7ie trainin5o>;le or as sel< learnin,

T@e Perinatal E>;ation Prora55e @as a 5o>;le on Pri5ar: Newborn Care t@at o7ers ro;tine

are o< t@e newborn,

.$ .$


32/47


LINC TRAINING

T@e LINC trainin is base> on t@e 6rini6le t@at t@ere are >ierent st:les an> >o5ains o< learnin

an> >ierent 5et@o>s enae >ierent learners,

A>;lt learners brin 6rior nowle>e an> e6eriene to t@e learnin sit;ation an> new nowle>e

s@o;l> be 6resente> in a ierent wa:s an> trainin 6rora55es nee> to inl;>e 7is;al= a;>itor: an> interati7e

5et@o>s,

A>;lt learners are 5oti7ate> b: tass 6erei7e> as 5eanineision 5aers an> selirete> learners, Presente> wit@ new ins assess5ent

Pre3rea>in an> a>>itional rea>in

Presentations

S5all ro;6 learnin to allow eas= >is;ssion an> re learner nee>s,

is;al >e5onstrations an> 6ratial sessions esine> as 6ersonal ai>s to ;i>e t@e @ealt@ worer in

5aternit: an> t@e neonatal ;nit in 6ro7i>in are to @a7e t@e5 o6en at all ti5es >;rin t@e o;rse, T@is

>e7elo6s 6ro7i>es a ontet elines,

R%'/!"# $%',"%, '"'$

T@e learner 5an;al e6lains t@e @arts an> 6ro7i>es baro;n> in

be s;55arie> in lass b: t@e ro;6, It an also be ;se> bei7i>;all: istane3base> learnin,

I"),/()!" ) T$+ &, "%," (',%

T@e 5an;al intro>;es a n;5ber o< tools t@at are ;se> to e> to

newborns, T@ese inl;>e

Newborn reor> as 6art o< t@e 5aternit: @art

.& .&


33/47


Obser7ation @art 5ission Reor> s5all newborns

Initial assess5ent treat5ent s;55ar:

"allar> sore

Fetal3in in t@e 5an;al, T@e written eerises ;s;all: re are ;se> to rein;les b: t@eoretial a66liation o< t@e

in are o< a newborn, A se6arate eerise boo is i7en to ea@

6artii6ant, Failitators @a7e t@e answers to t@e eerises in t@eir lesson 6lans,

R$%$'*+

Role36la:s are ;se> to e6lore o;nselin an> interations between @ealt@ worers,

V!+'$ $%',"!"#

Power6oint 6resentations or sli>e s@ows are ;se> to >e5onstrate linial sins an> are, T@is

reineos are in >e7elo65entas an alternati7e to t@e 6ower 6oint 6resentation, T@is will enable easier sel ai>

o no @a7e e6eriene> ;te> in t@e linial area 0Neonatal Unit an> Postnatal !ar>1 an>

ens;re t@at t@e 6artii6ants see an> 6ratie linial an> 6roe>;ral sills,

LINC CDROM

T@e CDROM ontains t@e e

LINC e an> Lesson Plans

.. ..


34/47


LINC Manae5ent o< Si an> S5all Newborn Learner Man;al an> !orboo

LINC Ro;tine Care Learner Man;al an> !orboo

LINC Power Point Presentation wors@o6

LINC PPIP ;i>eline an> wors@o6

PERINATAL EDUCATION PROGRAMME 0PEP1

T@is is a sel:= >istane e>;ation 6rora55e, It >oes not re?;ire t;tors= an> t@e onl: ost is

t@e 6;r@ase o< t@e 5an;als, T@ere are two rele7ant 5an;als Newborn Care, T@e Pri5ar: Newborn Care 5an;al is s;itable Mi>wi b: n;rses an> >otors >e6en>s larel: on t@eir abilit: to

aess a @i@ stan>ar> o< bot@ basi an> ontin;in trainin, T@is is 6arti;larl: i56ortant er3reso;re>= r;ral areas w@ere e>;ational s;66ort an> o66ort;nities

, Tra>itional 5et@o>s o< entralise> tea@in wit@ s5all lasses oe> to 5eet t@eir nee> as t@e: are e6ensi7e=

>e6en> on a>e?;ate n;5bers o< o56etent trainers an> re?;ire 6artii6ants to lea7e t@eir 6lae

o< e56lo:5ent, All t@ese er3ser7e> areas o< So;t@ Aer to a>>ress t@e @allenes o< better 6re7ention= >ianosis an> 5anae5ent o< o55onan> i56ortant 5e>ial on>itions= a 6aae o< ost3eeti7e an> 6ratial trainin 5et@o>s is

nee>e>, T@is s@o;l> inl;>e a s:ste5 o< sel: an> o3o6erati7e= ro;6 learnin to enable

@ealt@ are worers to tae 6artial res6onsibilit: ;ation an> 6roe a oo> baro;n> nowle>e an> ;n>erstan>in o< t@e

essential ste6s ;se> in a 6rotool3>ri7en a66roa@ to trainin an> @ealt@ are, Unless a 6artii6ant

nows w@: a ste6 in 5anae5ent is i56ortant= t@e: are ;nliel: to inor6orate w@at t@e: learn

into t@eir linial 6ratie,

A well3balane> 6rora55e o< trainin s@o;l> @a7e o56onents o< bot@ in>i7i>;al

st;>: an> ro;6 learnin as well as t;tore> eerises in linial sills, In t@is wa: a li5ite> n;5ber

o< trainers an 5anae 5an: 6artii6ants as ea@ ro;6 onl: nee>s li5ite> o56etene,

T@e Perinatal E>;ation Prora55e @as 6resente> a66ro6riate learnin 5aterial in 5aternal an>

newborn are @as enable> bot@ n;rses an> >otors= as well as 5e>ial

./ ./


35/47

Essential Newborn Carean> n;rsin st;>ents= to 6la: an ati7e role in t@eir own learnin 6roess, Co;rse boos ;se a

6roble53base> a66roa@ to a>>ress a wi>e rane o< to6is an> are @el6is;ssions, Usin a ?;estion3an>3answer ies an>

5anae5ent 6rotools= t@e: 6ro7i>e a loial a66roa@ an> lear ;n>erstan>in o< all ste6s in

6atient are, M;lti6le @oie tests be ae a7ailable on t@e internet ies @a7e >o;5ente> t@e siniBant i56ro7e5ent in

nowle>e= linial sills= attit;>es an> 6atient are 6raties w@en 5i>wi7es an> neonatal n;rses

;se t@is sel to 5anae t@eir own trainin 6rora55es, T@e ontent o< t@e

Perinatal E>;ation Care boos @as been inor6orate> into ot@er 6arts o< t@e Newborn Care

6aae, It is stronl: reo55en>e> t@at t@is beo5es an essential 6art o< neonatal e>;ation=

es6eiall: in ;n>er3reso;re> settins,

More ine> in t@e I56le5entation Tool - on Trainin in t@e net setion,

NEONATAL E-PERIENTIAL LEARNING

Neonatal E6eriential Learnin is an s;66orti7e o56re@ensi7e learnin 6rora55e base> on

linial o7ernane str;t;re, NELS ;tilises t@e Newborn Care PEP 5an;al >;rin a & wee

ontat session, More ine> in t@e a>>itional reso;res setion C@a6ter

/,

NE!"ORN ICU TRAINING

Few ;ni7ersities ;rrentl: oer Neonatal ICU trainin as t@e N;rsin Co;nil >oes not ;rrentl:

reister t@e o;rse, T@e sills 6ro7i>e> in t@is o;rse will beneBt n;rses at le7el & an> . it is @o6e> t@at t@e o;nil will soon reister NICU trainin,

IMPLEMENT PRE3SERICE TRAINING

Newborn are is re?;ire> to be 6art o< 6re3ser7ie n;rsin an> 5e>ial trainin, Pro7ine nee> to

ens;re t@at t@is is @a66enin an> t@at t@e: are ;6 to >ate,

CLINICAL MENTORING

Clinial 5entorin as 5entione> 6re7io;sl: is an i56ortant 6art o< learnin an> @el6in @ealt@

worers w@o @a7e been traine> i56le5ent w@at t@e: @a7e learne>,

., MONITORING AND AUDIT

A s:ste5 o< 5onitorin an> a;>it s@o;l> be establis@e> at ea@ e

$, S;66orti7e s;6er7ision

.( .(


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Essential Newborn Care&, Clinial A;>it

., Perinatal A;>it

/, Monitorin e: newborn in>iators

SUPPORTIE SUPERISION

E7er:bo>: w@o @as so5e role in o7erseein @ealt@ are is res6onsible tae res6onsibilit: ,

T@e n;rse 5anaer ens;res t@at t@ere are a>e?;ate n;rsin sta an> t@at t@e sta @a7e t@e

a66ro6riate nowle>e an> sills to be able to 6ro7i>e a @i@ ?;alit: o< are, He * s@e nee>s to

tae res6onsibilit:= wit@ t@e 5e>ial 5anaer an> ot@er sta= it o< reor>s an> ,

T@e , He * s@e nee>s to be a>7ise> b: t@e linial 5anaers an> liniians on

w@at is nee>e> an> w@at t@e o;to5e o< e7al;ations are= so t@at a66ro6riate ation an be taen,

T@e >otor is res6onsible a: to >a: basis, He * s@e nee>s to e7al;ateareit: an> 5ortalit:= looin s6eiBall: able ar> are, He * s@e nee>s to at in an a>7isor: a6ait: a: to >a: 6atient are an> t@e r;nnin o< t@e war>,

All @ealt@worers wit@ a s;6er7isor: stri7e to

De5onstrate t@e ri@t wa: to 6ere an enablin en7iron5ent in w@i@ t@eir ;nior ollea;es er t@eir s;6er7ision

Ass;5e as 5;@ res6onsibilit: an> ao;ntabilit: as is ;stiBable

.) .)


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CLINICAL AUDIT AND +UALIT# OF PATIENT CARE

Clinial a;>it re7iews @ow ;i>elines are i56le5ente>, T@ere are a n;5ber o< wa:s to 6erits,

$, A 6ae>iatriian on>;tin war> ro;n>s will re7iew all as6ets o< t@e 6atients are an>i55e>iatel: i>enti an> ba> linial 6raties an> >is;ss t@ese wit@ t@e 5e>ial

an> n;rsin tea5, T@is a;>it re?;ires an e6eriene> liniian a7ailable ro;n>s,

&, Clinial a;>it 6ratie= w@i@ an be a66lie> to a n;5ber oelines, T@is 5a: be ;seentielines,

., Reor> re7iew, T@e LINC sit;ation assess5ent an> are>itation ;tilises a reor> re7iew o

aainst stan>ar> are ition, T@e sores are totalle> an> a 6erentae ar> are ition is a@ie7e>, T@e reor> re7iew 5;st be on>;te> b:sille> liniians o tool it= an> one

en>orse> es tools to assist in olletin baseline >ata

an> a;>itin t@e a;se o< 6erinatal >eat@s,

Perinatal re7iew 5eetins s@o;l> be @el> e7er: 5ont@ in ea@ eat@ 5;st be assesse> wit@in &/ @o;rs o< t@e >eat@,

A"OUT PPIP FROM 0!!!,PPIP,CO,4A1

PPIP !ILL TA'E CARE OF THE NUM"ERS= !HILE #OU TA'E CARE OF MOTHERS AND THEIR "A"IES

T@e Perinatal Proble5 I>entiBation Prora5 0PPIP1 is a tool to 5ae :o;r 6erinatal an> 5aternal

>eat@ a;>it easier, It >oes not >o t@e a;>it io;s 6a6erwor o;t o< t@e

6roess, T@e 5o5ent :o; enter t@e basi >ata= :o; an instantl: >o etensi7e >ata anal:sis= an>

e7en 6resent :o;r >ata in ra6@s an> 6rint re6orts 3 all wit@ t@e 6ress o< a b;tton,

Let t@ere be no >o;bt 5e>ial a;>it 0an> ertainl: 6erinatal an> 5aternal >eat@ a;>it1 is not a

6roess t@at @a66ens wit@o;t >e>iate> in>i7i>;als s6en>in ti5e an> eort to 5ae it @a66en,

F;rt@er5ore= a;>it is a oesnVt Vlose t@e loo6V b: @anin t@e 6ratie it isa;>itin, T@e 6;r6ose o< a;>it is not t@e a;>it= or t@e B;res= or t@e re6orts it enerates= b;t t@e

i56ro7e5ent o< 6ratie, I< :o; >o not inten> to @ane t@e wa: :o; are t@eir

babies= PPIP will >o not@in


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Essential Newborn Carewei@e> an> 5eas;re> bea;se :o; want to >o better= PPIP will 6ro7i>e :o; wit@ an instr;5ent to

5ae sense o< :o;r >ata wit@o;t s6en>in @o;rs oin t@ro;@ >ata s@eets,

AUDIT SUPPORT PROIDED "# PPIP

Me>ial a;>it inl;>es a n;5ber o< ations, PPIP 5aes sense o< t@is 6roess b: 6ro7i>in :o; wit@t@ree Vle7elsV o< >ata entr:

DOING THE NUM"ERS

PPIP allows :o; to ollet n;5bers o< >eli7eries= stillbirt@s= earl: an> late neonatal >eat@s an>

5aternal >eat@s, T@is allows t@e al;lation o< >ierent rates 0e,, a 6erinatal 5ortalit: rate1 an>

is ;se> as >eno5inator in 7ario;s al;lations, A seletion o< V5isellaneo;sV >ata Bel>s allows

entr: an> anal:sis o< s6eiB >etail= e,, 5o>e o< >eli7er:,

IDENTIF#ING CAUSES

Ea@ 6erinatal= neonatal an> 5aternal >eat@ is entere> in 5ore >etail, PPIP allows entr: o< basi>e5ora6@i >ata= aeat@ an> a Bnal a;se o< >eat@ 5;st

be i>entiBe>, Ob7io;sl: t@ese a;ses an t@en be anal:e> in >etail,

AOIDA"LE

Lastl:= PPIP allows entiBation o< s6eiB a7oi>able ents relate> to

t@e ations o< t@e 5ot@er or @ealt@ are 6ersonnel= or t@e @ealt@ are s:ste5= w@i@ 5a: @a7e

altere> t@e o;to5e o< t@e s6eiB ase @a> it been 5anae> >ierentl:, Aain= t@ese a7oi>able

e> in >ata anal:sis,

F;rt@er in


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O;to5e o< s6eiB on>itions

See t@e atta@e> tools in A66en>i .= Neonatal reisters an> s;55ar: >ata

.9 .9


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STEP 5 TRACK PROGRESS AND UNDERTAKE ACCREDITATION

ASSESSMENTS

S)% 5: T,'(; ,#,%++ '"/ "/%,)';% '((,%/!)')!"'++%++%")+

In6;t H;5an an> Bnanialreso;res

Distrit tea5 in6lae

N;5ber o< >istrittea5s= reionalan> tertiar: @;5anreso;res

Proess A>7oa:Ation 6lans

Ation PlansTea5s in 6laeisits to

si>entiBe>

E?;i65ent nee>sTrans6ort nee>sTrainin nee>s

O;t6;t Nor5s an>stan>ar>sG;i>elinesTools ;se>N;5ber o< @ealt@worers traine>

Nor5s an>stan>ar>sTrainins on>;te>Retrans6ort 6oliiesNeonatal a5b;lanein 6lae

Pro7inial ob ai>s

O;to5e Failities are>ite> an>

stae>

+;alit: o< traininNo o< ite>

Reitation

I56at Neonatal 5ortalit:ratesPerinatal 5ortalit:ratesA>5issions6erentaes an>ase 5issions6erentaes an>ase 5issions6erentaes an>ase be 5onitore> at istrit an> 6ro7inial le7el, T@e @oie o< in>iators will

7ar: aor>in to t@e 6oint o< 5onitorin an> ;ni?;e ir;5stanes, It is ;seiators into t@e ( ateories s@own in t@e table abo7e, T@is will 6ro7i>e ;rin i56le5entation, An ea56le o< t@is 6roess is 6ro7i>e> in t@e table an>

s;bse?;ent >is;ssion below,

/% /%


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Essential Newborn CareAn Are>itation S:ste5 an> 6ro7i>es an inenti7e at t@e lose o< t@is @a6ter,

In6;t Proess O;t6;t O;to5e I56at

Failit: Le7el H;5an an>FinanialReso;res

Tea5 in6lae atrawn;6 in 7oa:wors@o6s

Co55;nit:

Healt@worers

Nor5s an>stan>ar>sentiBe>

G;i>elines in6lae

Wob ai>s in6lae an>bein ;se>

N;5ber o

Failitiesare>ite>on reor>re7iews

Neonatal5ortalit:rates

Perinatal5ortalit:rates

A>5issionrates an>ase Distritle7el

Tea5 in6lae in n;5ber oistrits

A>7oa:6rora55e

Ation 6lansin 6lae

N;5ber osan>G;i>elines in6lae

Traininson>;te>

A66ro6riatetransase


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reional@os6itals

Means oit

Are>itation 7isits

E?;i65enta;>its

PPIP >ata

DHIS Data

Stats SAData

INPUT INDICATORS

Monitor t@e b;>et an> @;5an reso;res

a>e?;ate reso;res istrit= reional an> >istrit @os6ital

le7el

Has t@e @os6ital re7italisation 6rora55e inl;>e> neonatal ;nits

Has t@e 6ro7ine i>entiBe> sta sta to 6ro7i>e newborn are

Has t@e 6ro7ine i>entiBe> >istrit s;66ort tea5s or eternal 5entors

PROCESS INDICATORS

T@is will >e6en> on t@e 6lan t@at was >rawn ;6 b;t 5a: inl;>e t@e o55;niate> to rele7ant stae@ol>ers

Has t@ere been a>7oa: at o55;nit:= @ealt@ worer an> 5anae5ent le7el

Ha7e ation 6lans been >e7elo6e> at ea@ i;5 an> lon

ter5 ati7ities

/& /&


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OUTPUT INDICATORS

!@at are t@e res;lts o< ation 6lans relate> to ;te> an> 6eo6le traine>

Ha7e t@e nor5s an> stan>ar>s been o56lete> an> a>o6te> b: elines in 6lae

Is t@ere a reeline an> trans6ort 6oli:

Are ot@er 6ro7inial ob ai>s in 6lae 5ission boo= newborn reor>=

5onitorin @arts

OUTCOME INDICATORS

O;to5e in>iators assess t@e o;to5e o< ations in ter5s o< ?;alit:,

!@at is t@e ?;alit: o< t@e trainin 6ro7i>e>

!@at is t@e ?;alit: o< 6atient are= is stan>ar> linial are bein 6ro7i>e> at it= an> o55;nit: satisitation s:ste5

>e7elo6e> b: LINC inl;>es an assess5ent o< t@e ?;alit: o< t@e ser7ie 6ro7i>e>,

IMPACT INDICATORS

T@e i56at in>iators 5eas;re w@et@er t@e ser7ie @as @a> an i56at an> a@ie7e> its obeti7es,

I< t@e obeti7e was to >erease neonatal 5ortalit: tren>s in t@e neonatal 5ortalit: rates 5;st be

5eas;re>,

I56at in>iators will not s@ow t@e >esire> i56ro7e5ent i< a 6roet @as not been i56le5ente> to

sale= or i< as6ets o< t@e i56le5entation @a7e been ino56lete,

T@e i56at 5eas;res e

Neonatal 5ortalit: rate

Intra6art;5 as6@:ia rates 0S" rates1

Ca;se s6eiB 5ortalit: rates

/. /.


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// //


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ACCREDITATION

T@e are>itation 6roess in Li56o6o was set ;6 to 5oti7ate= 5onitor an> rewar> @os6itals stan>ar>s a set linial stan>ar> itation s:ste5 inl;>es a n;5ber o< o56onents

Are>itation assesses all as6ets o< newborn are,

In Li56o6o Hos6itals a66l: itation one t@e: are rea>:, A tea5 onsistin o< eternal an>

internal 5e5bers 7isit an> assess newborn are, T@e latter is

assesse> b: reor> re7iew an> linial a;>it,

Hos6itals t@at @a7e a@ie7e> are>itation >i> so 5ostl: bea;se o< oo> linial are 6ro7i>e> to

newborns, T@ose t@at >i> not o e?;i65ent in 6lae b;t to 6ro7i>e an

a>e?;ate le7el o< linial are,

In t@e Brst ro;n> o< are>itation Sil7er= Gol> an> Platin;5 ranins aor>in

to t@e s:ste5 >esribe> below, T@e intention is t@at t@ese will be a>;ste> oitation,

Are>itation is 7ali> o< & ( :ears,

T@e are>itation ;tilises t@e o56re@ensi7e sit;ation assess5ent tools to assess


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Essential Newborn CareEa@ o< t@e ite5s in t@e Hos6ital isit @e3list 5;st be in 6lae wit@ a sore o< )(Q 6l;s

Criteria areas t@at are non3neotiable are

C@e list sore> )(Q 6l;s

$& ste6s to 'MC i56le5ente>

A>5ission reor>s ;se>

Obser7ation reor>s ;se>

O:en 5onitorin

Statistis a7ailable in t@e $%%% $999 birt@ wei@t

E7i>ene t@at t@e neonatal 5ortalit: rate in t@is wei@t ro;6 is i56ro7in

Le7el II s 0?;alit: o< are1 sore 5ore t@an )%Q

GOLD

All t@e riteria as >itional ite5s w@i@ are essential

C@e3list sores 2(Q 6l;s

CPAP a7ailable an> bein ;se> a66ro6riatel:

M;lti36ara5eter 5onitorin

In 5ortalit: rate in $(%% $999 birt@ wei@t ro;6 to less t@an (% * $%%%

Abilit: to inter6ret t@e 6erinatal statistis

o Patient reor>s 0?;alit: o< are1 sore 5ore t@an 2%Q

PLATINUM

All o< t@e riteria Gol>

A>>itional essential ite5s are

/) /)


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C@e3list sores 8(Q 6l;s

In3ser7ie trainin it 5eetins

Patient reor>s 0?;alit: o< are1 sore 5ore t@an 8%Q

Documents

Implementing Essential Newborn Care