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New Delhi Conference Proceedings Output As at 6Aug20.Docx Conference Proceedings (containing abstracts submitted for presentation at the postponed International Forum New Delhi July 2020) Conference Headline Sponsor New Delhi 2020 postponed until 2021, dates to be confirmed internationalforum.bmj.com/new-delhi @QualityForum #Quality2020 #Quality2021 One of the aims of the International Forum is to showcase improvement work from real and diverse healthcare settings to allow our attendees to learn and take away practical ideas that they can implement in their own organisation. This Conference Proceedings contains work submitted to us via our Call for Posters for the International Forum originally scheduled to take place in New Delhi, India, in July 2020. Due to the spread of COVID-19 around the world, including in South Asia, this International Forum is now postponed until 2021, dates to be confirmed. A big focus of the now postponed conference is to increase the awareness of the improvement work that is happening in the region. One of the key ways we do this is via the poster displays and abstract presentations available during the International Forum. We look forward to hosting these in 2021 and in the meantime we are pleased to bring to your attention a selection of projects submitted for presentation at the postponed July conference. Thank you to all those who have shared their work and have made it available in this digital format. We hope you enjoy this selection of abstracts and will join the International Forum improvement community to share your experiences, challenges, improvement successes and failures at our future events. Find out more about future International Forums at internationalforum.bmj.com. A QUALITY IMPROVEMENT STUDY ON IMPLEMENTATION OF PARTOGRAPH AND ITS EFFECT ON CLINICAL OUTCOME Call for Posters topic: Building Capability through Improvement Methods DR.RITU RAJ Medical College Hospital, Kolkata, India PROF. SOMAJITA CHAKRABORTY Diamond Harbour Government Medical College, West Bengal Background Obs & Gyne department, Eden hospital, Medical College, Kolkata, India. Even after years of policy by government of India, challenges to implementation exists. Problems analysed using 4Pmodel & Fishbone chart which were dealt step by step: PLACE: nonavailability of partograph in LR, less no. of labor beds POLICY: no order from authorities on compulsory filling of partograph, no sensitization lectures on partograph, lack of audits PEOPLE: less PG trainees on LR duty,no fixed LR team, no participation of Nurses & Internees in labor monitoring PROCEDURE: Lack of following: ● knowledge among trainees on Use & Benefits of partograph ● positive attitude toward partograph filling ● structural Organization & Supervision of labor monitoring ● proper handover during change of duty shift BASELINE DATA: Dec'17 of 9LR duty shifts,12 Hrs each, was: ● Total filled partographs in 122 parturients: 0 ● SNCU admission: 33.6% (birth asphyxia: 15.6%) ● Maternal complications: Prolonged labour: 45.1%, PPH:16.4%, Em CS:32.8%, Operative VD:0.8% Methods Interventions done using POCQI model: Step 1: Problem identified from Dec'17 baseline data and a team comprising of leader, communicators, doers, recorder, analyzer & strategy modifiers was formed. AIM formulated: at least 80% increment in implementation of partograph & 80% reduction in Obstetric & Perinatal complications from baseline. Step 2: Problems were analysed using 4Ps and fish bone chart as mentioned in background. Step 3: 5 PDSA cycles: 1 for each month and weekly data analysis using run charts: JAN'18: sensitization of residents, proper handover system FEB'18: new OBS BHT with inbuilt partograph, LaQSHYA program, more no. of labor tables MARCH'18: sensitization & involvement of new internees, structural organization of labour monitoring, supervision of LR APRIL'18: involvement of nursing staffs, weekly audits MAY'18: fixed LR pool team Step 4: Sustaining improvement: June'18 & July'18 Outcome Availability of partograph increased from 0% to 100% Implementation of partograph increased from 0% to 89.47% Total no. of deliveries in my study period (Jan'18 to July'18): 793 Total no. of partographs filled: 642 (80.95%) [Jan: 67.9%, Feb: 75%, March: 84.4%, April:82.7%, May:84.8%, June: 83.6%, July:89.5%]=>RISING TREND Total no. of completely filled partographs: 496 (62.5%) [Jan:39.1%, Feb: 49%, March: 56.0%, April:62.6%, May:75.2%, June:75.6%, July:82.4%]=>RISING TREND Birth asphyxia reduced gradually from 13 (Jan'18) to 0 (May'18) [p-value<0.0001] Apgar score improved significantly in partographed labour (p<0.0001) SNCU admission decreased over time (p-value<0.0001) Maternal complications reduced significantly in those with completed partographs (p-value<0.0001) Prolonged labour decreased over time (p-value<0.0001) PPH reduced over time (p-value<0.0001) % of Em CS deliveries decreased over time (p-value<0.0001) Operative VD increased over time due to timely intervention but statistically insignificant. Conclusion Improving partograph documentation required adequate resources, structural organization, constant monitoring, proper handover & supervision by seniors in LR. Regular review of performance & feedback meetings helped staffs develop a sense of ownership. Regular Tutorials & Workshops helped to enhance knowledge & skills. The problems faced during implementation were: ● not all team members attended tutorials ● training was conducted in small rooms failing adequate demonstration. Huge disparity in knowledge among HCWs on partograph required tiresome harmonization of these group. Partograph filling should be mandatory for all woman given trial of labor & implementation policy be strong to involve as many HCWs as possible. This study's success was because of correct problem analysis, change ideas, continuous data recording & timely actions. Hence achieving best practices of care in healthcare in most times does not require overhauling an entire heath system or requiring sophisticated technology. ADMINISTRATION OF INJECTION OXYTOCIN WITHIN 1 MIN AFTER DELIVERY OF BABY Call for Posters topic: Building Capability through Improvement Methods SAVITA RANI SINGHAL, NISHA MALIK, ROOPA MALIK, NEETU SANGWAN Deptt of Obstetrics and Gynecology, PGIMS, Pt BD Sharma Health University, Rohtak, Haryana, India Background This work was carried out in the Department of Obstetrics and Gynaecology, PGIMS, Rohtak, Haryana, India. WHO recommends the active management of the third stage of labour (AMTSL) for prevention of PPH, one of the components, includes administration of an uterotonic agent within one minute of delivery of the baby. In our institute, although injection oxytocin was administered after every delivery it was not being administered within one min after delivery of the baby. Keeping this in mind, we decided to undertake this simple but important project aimed at the administration of injection oxytocin within 1 min after delivery of the baby. In the baseline data it was observed, injection oxytocin was being administered within one minute of delivery of baby in only 20% of deliveries. The plan was to identify and evaluate the reasons for non-compliance with this policy. Methods A quality improvement team of 6 members including the consultant, trainees and nursing staff was made. On fishbone analysis, the following causes were identified: a) Lack of awareness among trainees and staff nurses b) Increased workload and inadequate manpower. All trainees and nursing staff were sensitized, motivated and emphasized the importance of the concept in meetings twice a week (07-09-2019 to 15-09-2019) and also through Whatsapp group messages (23-09-2019 to 30-09-2019). In order to reduce the workload, prefilled oxytocin syringes were kept ready in labour ward (at least 5 at one time) and undergraduate students posted in labour ward were trained for oxytocin administration if doctors and nursing staff were busy (16-09-2019 to 22-09-2019). To measure the effect of change, PDSA (plan-do-study-act) method was used to test every change idea. The feedback was taken from undergraduate students in the labour ward for an unbiased opinion. The results were analyzed weekly. Outcome A favourable outcome of an increase in the correct practice of administration of injection oxytocin during the third stage of labour among the trainees was observed. The primary outcome indicator improved gradually from a baseline of 20% to 87.3% in week 1 to 94.3% in week 2, 93.3% in week 3 and eventually to 95.7% after 4 weeks. During the first week, just a small change of spreading awareness and constant motivation led to around four-fold rise in the primary outcome indicator as compared to the baseline. The benefit of this work would be a reduction in the incidence of PPH, thus indirectly reducing maternal mortality. Conclusion After the start of the project, all the trainees and nursing staff are now sensitized and aware of this important concept of AMTSL. This simple and low-cost intervention can help avoid a major complication of PPH. The correct administration of this life-saving intervention in every delivery will help a long way in reducing the maternal mortality rate. At the start of the project there was a reluctance to change seen among the trainees, this problem was rectified by taking motivational lectures. The main message from our experience, just a small effort of creating awareness leads to a big leap and helps in a long way. Work as a team, keep motivating and encouraging and collect data from unbiased personnel. This practice will ensure safe maternal health in the
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