9th September, 2013 to 19th September, 2013 Rapid
Assessment District Hisar
Facility Readiness Assessment for Essential Newborn Care and Resuscitation
Child Health Division, NRHM, Haryana in technical collaboration with
Table of Contents Sr. No. Content Page No. 1. Objectives 2 2. Materials and Methods 2 3. List of facilities visited 2-3 4. General findings of District 3-4 4a. Overall Training Status 4 4b. Status of Newborn Corners 4 4c. Availability of equipment and instruments in NBCC 4 4d. Status of NBSUs 5 5. Quantitative findings of facilities 6-10 6. Qualitative findings of facilities 6 a. General Hospital, Hisar 10 6 b. General Hospital, Hansi 11 6 c. General Hospital, Adampur 11 6 d. CHC Aryanagar 12 6 e. PHC Balsmand 12-13 6 f. PHC Chaudhriwas 13 6 g. PHC Gawar 13-14 6 h. PHC Satrod Kalan 14 6 i. CHC Barwala 14 6 j. PHC Agroha 14 6 k. PHC Dhansu 15 6 l. PHC Landri 15 6 m. CHC Mangali 15-16 6 n. PHC Kaimri 16 6 o. PHC Ladwa 16 6 p. PHC Nalwa 16 6 q. PHC Talwandi Rukka 16-17 6 r. CHC Narnaund 17 6 s. PHC Khanda kheri 17 6 t. PHC Mirchpur 17 6 u. PHC Thurana 17 6 v. CHC Siswal 17 6 w. PHC Chuli Bagarian 17-18 6 x. PHC Dobhi 18 6 y. PHC Kajlan 18 6 z. PHC Neoli Kalan 18 6 aa. CHC Sisai 19 6 ab. PHC Data 19 6 ac. PHC Gurana 19-20 6 ad. PHC Umra 20 6 ae. CHC Sorkhi 21 6 af. PHC Baas 21 6 ag. PHC Puthi Saimain 21 6 ah. PHC Puthi Mangal Khan 21 6 ai. CHC Uklana 22 6 aj. PHC Daulatpur 22 6 ak. PHC Hasangarh 22-23 6 al. PHC Pabra 23 6 am. URCH Azadnagar 23
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1. Objectives:
1. Qualitative and quantitative assessment of readiness of our health facilities for essential newborn care and resuscitation. 2. To assess the quality of essential newborn care provided to each and every neonate immediately after birth. 3. To understand the existing knowledge, skills, attitudes and practices of the health service providers. 4. On the job trainings to the service providers on novelties in essential newborn care and resuscitation.
2. Materials and Methods
1. A structured and tested assessment tool has been used to assess the facilities on 8 parameters viz. facility identification and infrastructure, availability of services, human resource, Equipment and supplies, Register and client case records, protocols and guidelines, individual case records, knowledge and practices. 2. Knowledge and skill assessment has been done on the newborn simulators (mannequins). 3. The current and ideal practices in essential newborn care and resuscitation have been demonstrated to the service providers on the mannequins.
Our teams visited 39 facilities in the district, from 9th September, 2013 to 19th September, 2013, including General Hospitals, all CHCs and PHCs and the delivery huts with monthly delivery load of 3 or more. Following is the list of facilities visited:
Sr. No. Name of Facility 1. General Hospital, Hisar 2. General Hospital, Hansi 3. General Hospital, Adampur 4. CHC Aryanagar 5. PHC Balsmand 6. PHC Chaudhriwas 7. PHC Gawar 8. PHC Satrod Kalan 9. CHC Barwala 10. PHC Agroha 11. PHC Dhansu 12. PHC Landhri 13. CHC Mangali 14. PHC Kaimri 15. PHC Ladwa 16. PHC Nalwa 17. PHC Talwandi Rukka 18. CHC Narnaund 19. PHC Khanda kheri 20. PHC Mirchpur 21. PHC Thurana 22. CHC Siswal
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23. PHC Neoli Kalan 24. PHC Kajlan 25. PHC Dobhi 26. PHC Chuli Bagarian 27. CHC Sisai 28. PHC Data 29. PHC Gurana 30. PHC Umra 31. CHC Sorkhi 32. PHC Puthi Saimain 33. PHC Puthi Mangal Khan 34. PHC Baas 35. CHC Uklana 36. PHC Daulatpur 37. PHC Hasangarh 38. PHC Pabra 39. URCH Azadnagar
3. The findings of district Hisar in general are as follows: • Well established referral linkages at the time of delivery (Higher centers are catering mainly high risk deliveries). • Availability of staff (including medical officers) and attendants (Nursing staff) in most of the facilities. • New born care corners (NBCC) established in almost all the labour rooms. • Availability of reasonable number of trained staff in NSSK and IMNCI. • At birth immunization in many facilities. • Availability of resuscitation equipment in many facilities. • PHCs with availability of generators and 24*7 backup supply. • Availability of running water and toilets in the facilities. • Registers and records maintained in most of the facilities (Case sheets with uniformly printed formats). • Availability of Gynecologists in SDHs and CHCs. • Many birth attendants not trained in SBA. • Hand washing stations not appropriate for effective hand washing. Effective hand washing before delivery not followed. • Simplified Partographs not available in many facilities. • Partographs maintained in many facilities but method is not correct and in most cases these are filled after delivery for record completion. • Autoclave available but not used in some facilities. • Home deliveries in some areas of the district due to unavailability of 24*7 services in some PHCs. • Birth preparedness before delivery not done in some facilities. • Labour room protocols for infection prevention not followed in routine.
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• Case sheets do not have records of essential newborn care. • Suction of every new born in practice despite good cry. • Immediate cord cutting in practice. • Infection prevention and hygiene protocols for labour room and NBCC are not followed in majority of the facilities. • Bag and Mask used for resuscitation. Chronology of resuscitation is not clear (PSSR not followed). Steps are not in chronological order (Resuscitation equipment are not available) • Use of Bag and Mask not appropriate. • Regular refresher trainings needed for resuscitation. • AMTSL practices are not followed in some facilities. • Skin to skin contact not in practice. • Use of Radiant Warmer and separation of every newborn from mother is in practice. • Skills of essential newborn care lacking. • Immediate drying not followed in many facilities • Management of low birth weight babies not done as per protocols
4 a. Overall Training Status
Sr. No. No. of Birth attendants SBA NSSK IMNCI
1. 204 113 167 135
4 b. Status of Newborn Corners
Newborn Corners Newborn Total NBCCs NBCCs still not with Radiant Corners with Established established Warmer 200 W bulb
36 (39) (No labour 19 37 (18 with both One (Recently shifted to room in Mirchpur) Bulb and warmer) new building URCH Azadnagar)
4 c. Availability of equipment and instruments in NBCCs (n=39)
Sr. No. Equipment/Instrument Available (No. of Not available (No. Facilities) of Facilities) 1. Self-Inflating Bag 39 0 2. Mask Size ‘1’ 38 1(Gawar)
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3. Mask Size ‘0’ 35 (4) Choudhriwas GH Hisar (LR) Talwandi rukka Daulatpur
4. Shoulder Roll 38 1 5. Suction Catheter 37 2 (Pabra and Sisai) 6. Disposable Mucus Extractors 37 2 (Puthi Samain, Suryanagar)
7. Suction Machine 39 0 8. Oxygen Cyinder 37 2 (URCH Azadnagar and Suryanagar)
9. Baby Sheets 38 1 (Balsamand) 10. NBCC at appropriate place 33 6 (changes suggested on site)
4 d. Status of Designated Newborn Stabilization Units (NBSUs)
Sr. No. Name of Status Functionality No. of Radiant No. of Institution Warmers Phototherapy Units 1. SDH Hansi Established Not Functional 1 1
2. CHC Barwala Not NA Only in NBCC 0 Established 3. CHC Mangali Not NA Only in NBCC 1 Established 4. CHC Uklana Not NA Only in NBCC 1 Established 5. CHC Aryanagar Not NA Only in NBCC 1 Established
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4. Quantitative Analysis of various facilities (n= 37)
Score 75% and Above Score 51% to 74% Score 50% and less
Registers Knowledge Delivery And Essential Drugs, Provider And Facility’s Name Of Protocols And About Infrastructure Newborn Care Equipment And Knowledge Client Overall Facility Guidelines Infection Services Supplies And Skills Case Average Prevention Records
CHC Barwala 85 78 87 80 57 66 75 75
PHC Chuli 69 89 79 70 57 70 75 73 Bagrian
PHC Landri 79 83 72 70 71 72 61 73
PHC Nalwa 98 89 77 50 71 46 69 71
PHC Putty 75 89 82 70 71 39 67 71 Mangal Khan
CHC Mangali 67 72 72 70 57 65 73 68
PHC Khanda 88 78 80 60 57 54 58 68 Kheri
GH Hisar 63 89 84 70 57 59 50 67
GH Hansi 67 89 80 70 57 52 56 67
CHC 71 72 74 60 57 66 66 67 Narnaud
SDH 87 83 74 80 29 61 50 66 Adampur
PHC Ladwa 75 83 79 80 29 55 59 66
CHC Sorkhi 79 89 71 70 43 49 56 65
PHC 81 83 74 60 43 46 62 64 Neolikalan
PHC Sisai 81 89 60 60 43 61 49 63
PHC Agroha 65 78 76 80 29 57 55 63
PHC Gurana 77 83 72 90 14 53 47 62
PHC Kaimri 81 78 66 70 43 46 52 62
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CHC Arya 81 89 79 60 14 48 61 62 Nagar
PHC Bass 63 89 81 60 29 39 66 61
PHC Dobi 42 83 74 80 43 45 57 61
DISTRICT 72 82 73 64 36 51 49 61 AVERAGE
PHC Datta 65 83 70 90 14 50 47 60
PHC Satrod 52 78 79 60 43 55 50 60 Kalan
PHC Dhansu 69 83 68 60 29 48 56 59
PHC Kajlan 48 83 80 50 29 57 57 58
PHC Pabra 73 83 60 40 43 50 52 57
PHC 88 78 64 50 29 37 41 55 Hassangarh
PHC 75 83 73 60 29 31 36 55 Puthisamain
PHC Umra 67 72 73 60 29 46 28 54
CHC Uklana 71 94 70 50 0 44 46 54
PHC 69 83 60 50 14 46 48 53 Daulatpur
PHC 77 83 60 40 14 43 51 53 Talwandi
PHC 62 72 61 60 29 45 36 52 Balsamand
PHC Gawar 75 72 65 60 14 50 6 49
PHC 71 67 66 60 29 50 0 49 Chaudhariwas
PHC Thurana 79 78 72 60 0 33 7 47
URCH Azad 58 78 73 60 0 40 0 44 Nagar
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Graph 1. Status of Infrastructure (n=37)
98 100 88 88 87 85 81 81 81 81 79 79 79 77 77 75 75 75 75 80 73 72 71 71 71 69 69 69 67 67 67 65 65 63 63 62 58 60 52 48 42 40
20
0
Graph 2. Scores of infection prevention knowledge in providers (n=37)
Knowledge of Infection Prevention 100
80 717171
57575757575757 60 43434343434343 40 36 2929292929292929292929
20 141414141414 0 0 0 0
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Graph 3. Status of Registers and Client Case record maintenance (n=37)
Registers and Client Case records 100
80 75 75 73 69 67 66 66 62 61 61 59 60 58 57 57 56 56 56 55 52 52 51 50 50 50 49 49 48 47 47 46 41 40 36 36 28
20 7 6 0 0 0
Graph 4. Availability of Essential Drugs, Equipment and Supplies (n=37)
Essential Drugs, Equipment And Supplies 100 87 84 82 81 80 80 80 79 79 79 79 77 80 76 74 74 74 74 73 73 73 73 72 72 72 72 71 70 70 68 66 66 65 64 61 60 60 60 60 60
40
20
0
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Graph 5. Status of skills in essential newborn care and resuscitation (n=37)
100
80 72 70 66 66 65 61 61 59 57 57 60 55 55 54 53 52 51 50 50 50 50 49 48 48 46 46 46 46 46 45 45 44 43 40 39 39 37 40 33 31
20
0
5. Facility wise Qualitative Findings a. GH Hisar All staff nurses not trained in SBA, IMNCI and F-IMNCI. Injection Dexamethasone not available Glucose 5% and Ringer’s lactate not available Injection Vitamin K not available and not administered. Toilet not available in the labour room. Partograph not filled regularly. Baby weight not mentioned on new born case sheets. Record of birth asphyxia and essential new born care not available All new born having signs of birth asphyxia are directly referred to SNCU for further management, So no further record of such new born is not available in the labour room. Recommendations
Arrange for trainings of staff nurses. Make all the essential and life-saving drugs available. Govt. of India has recommended injection vitamin K for all newborns. Make injection vitamin K available and ensure its administration to every newborn within first hour of birth (1mg for babies >1000 gm and 0.5mg for babies weighing <1000 gm, IM in antereo-lateral aspect of mid-thigh.). Maintain record of essential newborn care and birth asphyxia in the case sheets.
10 | P a g e b. GH Hansi Very well maintained labour room with established newborn corner. NBCC is also established in OT with 200 W bulb. Infection prevention protocols are not followed as per guidelines. All the oxygen cylinders are without humidifiers and flow-meters. Newborn Stabilization Unit (NBSU) is not established. Knowledge of staff nurses about essential newborn care and resuscitation is average. Skills of all the staff nurses about essential newborn care and resuscitation are below average and needs great improvement.
Recommendations
Follow infection prevention protocols as per guidelines. Get humidifiers and flow-meters attached to oxygen cylinders in labour room and OT. Establish and functionalize NBSU in the hospital. Train at least two nurses for Facility Based Newborn Care (FBNC) for smooth functioning of NBSU. c. SDH Adampur Separate septic and aseptic labour room available. 1 phototherapy machine available but not in use. 2 radiant warmers available. Infrastructure is underutilized 11 staff nurses available, only 4 of which are SBA trained Rusted delivery instruments in labour room Shoulder roll not available Practice of immediate cord cutting Resuscitation skills lacks chronology Vitamin K not in practice Documentation of essential newborn care is not being done Partographs are not being filled Infection prevention protocols not being followed.
Recommendations
Arrange for trainings of staff nurses. Establish and functionalize NBSU. Train at least two nurses for Facility Based Newborn Care (FBNC) for smooth functioning of NBSU. Govt. of India has recommended injection vitamin K for all newborns. Make injection vitamin K available and ensure its administration to every newborn within first hour of birth (1mg for babies >1000 gm and 0.5mg for babies weighing <1000 gm, IM in antereo-lateral aspect of mid-thigh.). Maintain record of essential newborn care and birth asphyxia in the case sheets.
11 | P a g e d. CHC Arya Nagar Hand washing station is not appropriate. Infection prevention in labour room needs improvement. Notes regarding baby need to be mentioned in case sheets. Skin to skin contact should be made during delivery for temperature maintenance naturally. Cord should be cut with new blade every time. Immediate Breast feeding should be done. Vitamin K should be administered at birth.
Recommendations
Make hand washing station appropriate as suggested during visit. Follow infection prevention protocols as per guidelines. Maintain record of essential newborn care and birth asphyxia in the case sheets. e. PHC Balsamand Home deliveries are prevalent in the area. Most of the deliveries are being conducted at home by a trained birth attendant (Dai). There are many reported cases of still birth. Private RMP Doctors are also prevalent in the area No separate PNC ward is available. Out of three staff nurses posted none is trained in SBA. All staff nurses not trained in F-IMNCI. Vitamin K not administered to the new born before discharge At birth immunization not done before discharge (Only zero polio is given). Baby cloth not available Inj Vitamin K not administered to the new born Normal saline inj. Epinephrine not available Tab Folic acid not available. Baby botes not available in records. GPLAD not mentioned in case sheets. Injection oxytocin is given to every new born after delivery. Low birth weight new born (<1800gm) are not referred to GH/SNCU. Infection prevention protocols not followed. Autoclave not available and not used Knowledge regarding immediate care to new born within one hour after delivery need improvement. Partographs are filled but just for record completion and most of them are filled after delivery. Sign and symptoms of infections in newborn, low birth weight baby’s management knowledge need up-gradation. Knowledge regarding the signs of birth asphyxia and management thereafter need hand holding support from the Medical officer in-charge.
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Recommendations
Improve institutional facilities and services to curtail home deliveries. Motivate people for institutional deliveries and benefits associated. Arrange for trainings of staff nurses. Start administering BCG-birth dose, Hepatitis B birth dose and OPV-0 and injection vitamin k to every newborn. Make all the essential and life-saving drugs available. Follow infection prevention protocols as per guidelines. Promote peer learning and refresher trainings to improve knowledge of birth care providers. f. PHC Chaudhariwas Very well equipped labour room but only one delivery in past six months. Newborn corner not established in labour room. Radiant warmer or 200 W bulb as a source of heat, baby face mask of size ‘0’ and shoulder roll not available. Hand washing area is not appropriate. Though there are elbow taps but are placed very low which hinders effective hand washing. Knowledge of staff nurse about essential newborn care and resuscitation is below average and holds scope for improvement. Skills of staff staff nurse about essential newborn care and resuscitation are below average.
Recommendations
Increase delivery load to justify infrastructure and equipment. Establish NBCC as discussed during the visit. Improve hand washing stations as discussed during visit to ensure effective hand washing. Promote peer learning and refresher trainings to improve knowledge of birth care providers. g. PHC Gawar Equipped labour room but only 5 deliveries in past 6 months. Newborn corner established with all necessary equipment. Baby face mask of size ‘1’ is not available. Knowledge of staff nurse about essential newborn care and resuscitation is below average and holds scope for improvement. Skills of staff staff nurse about essential newborn care and resuscitation are below average.
Recommendations
Increase delivery load to justify infrastructure and equipment. Improve hand washing stations as discussed during visit to ensure effective hand washing. Provide baby face mask of size ‘1’ in NBCC.
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Promote peer learning and refresher trainings to improve knowledge of birth care providers. h. PHC Satrod Kalan: All newborns were being shifted to NBCC. Milking of cord was in practice. Cord cutting was being done just after delivery of newborn. Bed head tickets were partially filled. AMBU bag Autoclave is not in practice. Recommendations:
There is no need to shift all newborns to NBCC. Only those who require special care i.e. basic resuscitation or resuscitation with AMBU bag are required to be shifted. Cord should be cut with sterile blade, milking of cord is not recommended and cord cutting should be done with a gap of 1 to 3 minutes after birth. i. CHC Barwala Facility designated for NBSU during visit space identified and communicated to SMO need to establish NBSU as soon as possible NBCC established at labour room need to keep a shoulder roll (0.5 to 1 inch diameter), baby sheets are to be arranged as per delivery load (for 30 delivery per month 6 to 10 sheets required ) Essential Newborn Care and Resuscitation knowledge inadequate at facility during visit we took session on this SMO should ensure same knowledge should be in practice. Hygiene should be maintain in labour room area during visit we took session about infection prevention and hygiene facility in charge should ensure implementation/practice Delivery and Newborn registers provided to facility should fill all delivery and its events in it. Every newborn should room in with mother. j. PHC Agroha: Unclean machintosh available on delivery table. Inappropriate size of shoulder roll was available at radiant warmer. PNC ward was not clean which provides uncongenial environment for mother and newborn. Autoclaving of AMBU Bag and masks is not in practice. Delivery table cushion (bed) plastic cover is torn. Provide new cushion for delivery table. Recommendations:
The shoulder roll should be made of 1-1/4 inch broad for appropriate support. AMBU bag should be autoclaved on regular basis. Elbow tap should be made available for labor room so that proper hand washing techniques should be followed. Machintosh once used should be cleaned after every delivery and if torn or cut, should be discarded off.
14 | P a g e k. PHC Dhansu Congested labour room and NBCC. All essential equipment available and functional at NBCC. Good record keeping. Case files complete in most senses except notes of immediate newborn care. Infection prevention seems highly compromised and not practiced as per guidelines. Knowledge of staff nurses about essential newborn care and resuscitation is average. Skills of all the staff nurses about essential newborn care and resuscitation are below average and needs great improvement.
Recommendations
Start writing notes on essential newborn care as discussed during the visit. Improve infection prevention by following guidelines. Promote peer learning and refresher trainings to improve knowledge of birth care providers. l. PHC Landri Well maintained delivery room with appropriately placed NBCC. Skills of staff nurses are good about – o Essential new born care. o Identification of Birth Asphyxia. o Process of Resuscitation. Well maintained case sheets available with appropriate case notes. Infection prevention and hygiene protocols are not followed for NBCC.
Recommendations
Maintain sterile environment at NBCC. Sterilize Bag and Mask regularly. Suction machine bottles should contain 3% phenol or 5% Lysol. m. CHC Mangali CHC having space constraint so no properly designated PNC and ANC room. No designated area for boiling and autoclaving, duty room for nurses and utility rooms for linen. Injection Adrenaline not available. Infection prevention protocols not followed regularly. One staff nurse not trained in SBA, NSSK and two are not trained in IMNCI. Skills for resuscitation need improvement.
Recommendations
Follow infection prevention protocols as per guidelines.
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Arrange for trainings of staff nurses for SBA, NSSK and F-MNCI. n. PHC Kaimri Well maintained labour room with appropriate NBCC with all necessary equipment. Apparently there is no birth preparedness before delivery. Knowledge of staff nurses about essential newborn care and resuscitation is average. Skills of staff nurses about essential newborn care and resuscitation are below average. Record keeping in registers and case sheets is good but baby notes need improvement and notes on essential newborn care are to be incorporated in the registers.
Recommendations
Birth preparedness is integrated part of delivery process. Improve birth preparedness to avoid eleventh hour hassles. Start writing notes of essential newborn care on case sheets as discussed during the visit. Promote peer learning and arrange for refresher trainings to improve knowledge and skills of staff nurses. o. PHC Ladwa NBCC established but not on proper place during visit we identified place need to install NBCC on identified place Suction of every newborn in spite of well cry and breath need to discourage Every newborn kept at NBCC need to discourage for normal newborn and mother Shoulder role need to replace / prepare as directed during visit Unhygienic blood stained labour table and mechantose need to take immediate action Bed heads sheets records were inadequate required to capture delivery and newborn care events in detail p. PHC Nalwa Report not received yet. q. PHC Talwandi One staff nurse is not trained in NSSK. Infection prevention and hygiene protocols not followed. Immediate cord cutting is in practice. Skin to skin contact is not maintained. Every new born is shifted to radiant warmer.
Recommendations
Ensure cord cutting between 1-3 minutes after delivery. Ensure skin to skin contact is maintained immediately after every normal delivery to prevent hypothermia. Ensure immediate breastfeeding after every normal delivery.
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Ensure infection prevention and hygiene. r. CHC Narnaud Mechanical baby weighing scale not working properly. Flow meter and pressure valve of oxygen cylinder in labour room is not working. Normal saline not available Case records need improvement Partographs are not filled regularly and need improvement. Skills for resuscitation and essential new born care need improvement. Injection Vitamin K not administered. At birth immunization not done. Recommendations
Start administering BCG, Hepatitis-B birth doses, OPV-0 dose and injection vitamin K to every newborn. Maintain case records and patograph of each delivery properly as discussed during visit. Also, write detailed notes on essential newborn care and resuscitation. s. PHC Khanda Kheri Suction of every newborn in spite of good cry and breathing. Practice of keeping every newborn at NBCC. Shoulder roll needs replacement. Prepare as suggested during visit. Administration of antibiotic to mother before every delivery need to discourage for normal mother Immediate cord cutting is usual practice at facility. There is need to discourage this practice and to promote delayed cord cutting (between 1 to 3 min after birth). Recommendations
Discourage suction of every newborn. Suction is required in cases where signs of asphyxia are apparent. Only those babies are to be taken to NBCC who require resuscitation. Practice skin to skin contact between mother and baby in all cases where vitals of both are WNL. t. PHC Mirchpur
There is no labour room in this PHC. u. PHC Thurana Report not received yet.
v. CHC Siswal Report not received yet.
w. PHC Chuli Bagrain NBCC well established with well displayed IEC and equipment uses guidelines Expired drug mechanism well followed.
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Office order displayed for routine immunization in labour room Well maintained delivery and newborn records Well maintained referral register Shoulder roll needs replacement. Prepare as suggested during visit. Milking of cord is usual practice at facility. Milking of cord is not recommended these days, so, please discourage this practice. x. PHC Dobi: Vitamin K, Hep B, and BCG at birth doses were not being given. Shoulder roll was present, but was not of appropriate size. AMBU Bag autoclave was not in practice. Bed head tickets does not contain all vital events, at places it was partially filled. Recommendations:
Birth doses of Vit K, Hep B, OPV, and BCG should be given to all newborns with a mention in bed head tickets and discharge slip as well. The shoulder roll should be made of 1-1/4 inch broad for appropriate support. AMBU bag should be autoclaved on regular basis. y. PHC Kajlan Suction of every newborn in spite of good cry and breathing. Practice of keeping every newborn at NBCC. Shoulder roll needs replacement. Prepare as suggested during visit. Administration of antibiotic to mother before every delivery need to discourage for normal mother Immediate cord cutting is usual practice at facility. There is need to discourage this practice and to promote delayed cord cutting (between 1 to 3 min after birth). Recommendations
Discourage suction of every newborn. Suction is required in cases where signs of asphyxia are apparent. Only those babies are to be taken to NBCC who require resuscitation. Practice skin to skin contact between mother and baby in all cases where vitals of both are WNL. z. PHC Neolikalan: Vit K at birth dose is not given. Shoulder roll was not of proper size. All staff nurses were NSSK trained, but unable to show required skills for resuscitation. Recommendations:
At birth dose of Vitamin K should be given to all newborns. The shoulder roll should be made of 1-1/4 inch broad for appropriate support. Regular monitoring and peer learning is recommended to improve the skills.
18 | P a g e aa. CHC Sisai: Very good knowledge of staff nurses regarding ANC checkup, Detection of danger sign in newborn, management of 3rd stage of labor, newborn routine care for normal delivery. Birth preparedness for delivery and newborn care found to be adequate. Average hospital stay of delivery women is approximately 12 hours. Well maintained NBCC. Timely disinfection of instruments and disposal of waste as per guidelines are followed.
Recommendations:
Housekeeping protocols are required to be followed. Pressure of suction machine at NBCC should be maintained between 80 to 100 mmHg for neonatal suction. ab. PHC Datta
Separate breast feeding room available with a chair and breast feeding kit. This is a very good initiative Record maintenance poor. Partographs are filled incompletely and inaccurately Documentation of essential newborn care is lacking Documentation of baby resuscitated with bag and mask not available Disinfection of bag and mask is not in practice Practice of immediate cord cutting Resuscitation skills lack chronology. Double gloving not in practice. NBCC well established.
Recommendations
Improve record keeping. Maintain partograph properly. Start writing notes on essential newborn care in case sheets. Follow infection prevention protocols as per guidelines. Practice delayed cord cutting (between 1 to 3 minutes of birth). ac. PHC Gurana
Immunization of newborn in practice Double gloving not in practice Practice of separating every newborn from mother despite good cry. Practice of milking of cord Practice of immediate cord cutting Resuscitation skills lacks chronology Record keeping poor. Partographs incompletely and inaccurately filled
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Documentation of essential newborn care not being done Bag and mask not being disinfected regularly Staff nurse does not know the dose of Vitamin K.
Recommendations
Improve record keeping. Maintain partograph properly. Start writing notes on essential newborn care in case sheets. Follow infection prevention protocols as per guidelines. Practice delayed cord cutting (between 1 to 3 minutes of birth). Govt. of India has recommended injection vitamin K for all newborns. Make injection vitamin K available and ensure its administration to every newborn within first hour of birth (1mg for babies >1000 gm and 0.5mg for babies weighing <1000 gm, IM in antereo-lateral aspect of mid-thigh.). ad. PHC Umra
Tap in the hand washing area is not elbow operated. One staff nurse not trained in SBA and IMNCI. Injection hydrocortisone not available Need improvement in knowledge regarding care of low birth weight and premature baby Knowledge regarding sign of infection prevention and management need improvements. Knowledge regarding sign and symptoms of birth asphyxia and management thereafter need regular refreshers. Newly recruited staff nurses are not trained in SBA, NSSK and IMNCI. Partographs are not filled regularly. Infection prevention protocols are not followed Injection Vitamin K not administered
Recommendations
Arrange for trainings of staff nurses. Make all the essential and life-saving drugs available. Govt. of India has recommended injection vitamin K for all newborns. Make injection vitamin K available and ensure its administration to every newborn within first hour of birth (1mg for babies >1000 gm and 0.5mg for babies weighing <1000 gm, IM in antereo-lateral aspect of mid-thigh.). Maintain record of essential newborn care and birth asphyxia in the case sheets. Promote peer learning and arrange for refresher trainings to improve knowledge and skills of staff nurses.
20 | P a g e ae. CHC Sorkhi
Well established labour room. Newborn corner established with all necessary equipment. Hand washing station is not appropriate and taps are low in height. As per the knowledge and skill test of the staff nurses it is apparent that there is practically no birth preparedness before delivery. Knowledge of two staff nurses about essential newborn care and resuscitation is average and of one staff nurse is below average. Skills of all the staff nurses present for essential newborn care and resuscitation are below average. Record keeping in registers and case sheets is generally good but case sheets lack record of essential newborn care.
Recommendations
Birth preparedness is integrated part of delivery process. Practice meticulous birth preparedness to avoid eleventh hour hassles. Maintain record of essential newborn care and birth asphyxia in the case sheets. Promote peer learning and arrange for refresher trainings to improve knowledge and skills of staff nurses. af. PHC Bass
Report not received yet. ag. PHC Puthisamain:
Sufficient numbers of baby sheets were not available, and were not autoclaved. Machintosh sheet was blood stained and with lots of cracks on it. Disposable mucus sucker was not available. Shoulder roll was not as per required height. Partograph was being filled in wrong manner. Recommendations:
Baby sheets should be available in sufficient quantity, which should be autoclaved before use. Machintosh sheet should be changed on regular basis as it gets any permanent stain or any crack. It should be wiped out and washed after every use or delivery. Disposable mucus sucker is desired for suction and should be made available. Shoulder roll was made by team member, but should be cleaned on regular basis and needs to be made as per direction after washing / autoclave. Partograph should be filled in correct manner. ah. PHC Puthi Mangal Khan
Report not received yet.
21 | P a g e ai. CHC Uklana
Immediate cord cutting is in practice. Skin to skin contact is not maintained. Every new born is shifted to radiant warmer. Staff nurses have average skills for neonatal resuscitation. Infection prevention and hygiene protocols are not followed.
Recommendations
Ensure cord cutting between 1-3 minutes after delivery. Ensure skin to skin contact is maintained immediately after every normal delivery to prevent hypothermia. Ensure immediate breastfeeding after every normal delivery. Ensure infection prevention and hygiene. aj. PHC Daulatpur
One staff nurse is not trained in NSSK. Zero size mask not available. Staff nurses have average knowledge about essential new born care. Immediate cord cutting in practice. Shoulder roll not available. Staff nurses have poor skills for neonatal resuscitation.
Recommendations
Ensure availability of all equipment for NBCC. Unavailability of the same may cause neonatal death. Skills of staff nurses need to be improved through regular monitoring and handholding. ak. PHC Hassangarh
Hand washing station not available. Oxytocin being used for augmentation of labour. Rusted delivery instruments. Staff nurse given additional charges of Death/birth, cold chain. Only 2 staff nurses available. Staff nurse available at night is not SBA, NSSK trained. Double gloving not in practice. Practice of separating every newborn from mother despite good cry. Practice of milking of cord. Practice of immediate cord cutting. Resuscitation skills lack chronology.
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Record keeping poor. Partographs are not being filled. Documentation of essential newborn care not being done. Infection prevention practices are not being followed.
Recommendations
Make appropriate hand washing station. Arrange for trainings of staff nurses. Discourage milking and immediate cutting of cord. Cut cord between 1 to 3 minutes of birth. Follow infection prevention protocols as per guidelines. Keep appropriate record of essential newborn care as discussed during the visit. al. PHC Pabra Report not received yet. am. URCH 14 Azadnagar
Suction of every newborn in spite of good cry and breathing. There is need to discourage this practice. After delivery every newborn is taken to NBCC. There is need to discourage this practice. Practice skin to skin contact between mother and baby if vitals of both are WNL. Shoulder roll needs replacement. Prepare shoulder roll as suggested during the visit. Milking of cord is usual practice at facility. Discourage milking of cord. Immediate cord cutting is usual practice for every newborn need to cut cord within 1 to 3 minute in case of good cry and breathing in newborn. Augmentation of labour by oxytocin is usual practice at facility. Discourage this practice. Need to promote Skin to skin contact for normal newborn and stable mother.
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