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Labour Room Quality Improvement Initiative (LaQshya).pptx

  1. Dr. Anjalatchi Muthukumaran Vice principal Era College of Nursing , Era University ,Lucknow 226003 Labour Room Quality Improvement Initiative (LaQshya) case report status
  2. Point to be discussed  About the Scheme  Aim  Goal  Objectives  Strategies  Scope  Institutional Arrangement  Targets
  3. About the Scheme  After launch of the National Health Mission (NHM), there has been substantial increase in the number of institutional deliveries.  However, this increase in the numbers has not resulted into commensurate improvements in the key maternal and new-born health indicators.  It is estimated that approximately 46% maternal deaths, over 40% stillbirths and 40% newborn deaths take place on the day of the delivery.  A transformational change in the processes related to the care during the delivery, which essentially relates to intra- partum and immediate postpartum care, is required to achieve tangible results within short period of time.  ‘LaQshya’ programme of the Ministry of Health and Family Welfare aims at improving quality of care in labour room and maternity Operation Theatre (OT).
  4. Introduction  It’s a multipronged approach focused at Intra- partum and immediate postpartum period. Aim  To reduce preventable maternal and newborn mortality, morbidity and stillbirths associated with the care around delivery in Labour room and Maternity Operation Theatre and ensure respectful maternity care.
  5. Objectives  To reduce maternal and newborn mortality & morbidity due to APH, PPH, retained placenta, preterm, preeclampsia & eclampsia, obstructed labour, puerperal sepsis, newborn asphyxia, and sepsis, etc.  To improve Quality of care during the delivery and immediate post-partum care, stabilization of complications and ensure timely referrals, and enable an effective two-way follow-up system.  To enhance satisfaction of beneficiaries visiting the health facilities and provide Respectful Maternity Care (RMC) to all pregnant women attending the public health facility.
  6. Strategies  Reorganizing/aligning Labour room & Maternity Operation Theatre layout and workflow as per ‘Labour Room Standardization Guidelines’ and ‘Maternal & Newborn Health Toolkit’ issued by the Ministry of Health & Family Welfare, Government of India.  Ensuring that at least all government medical college hospitals and high case- load district hospitals have dedicated obstetric HDUs as per GoI ,MOHFW Guidelines, for managing complicated pregnancies that require life-saving critical care.  Ensuring strict adherence to clinical protocols for management and stabilization of the complications before referral to higher centres.
  7. Scope of services  Following facilities would be taken under LaQshya initiative on priority:  All government medical college hospitals.  All District Hospitals & equivalent healthy facilities.  All designated FRUs and high case load CHCs with over 100 deliveries/60 (per month) in hills and desert areas.
  8. Institutional Arrangement  Under the National Health Mission, the States have been supported in creating Institutional framework for the Quality Assurance – State Quality Assurance Committee (SQAC), District Quality Assurance Committee (DQAC), and Quality Team at the facility level.  These committees will also support implementation of LaQshya interventions.  For specific technical activities and program management, special purpose groups have been suggested, and these groups will be working towards achievement of specific targets and program milestones in close coordination with relevant structure.
  9. Targets of the program  Immediate (0-4 Months)  80% of the selected Labour rooms & Maternity OTs assess their quality and staff competence using defined NQAS checklists and OSCE.  80% of Labour rooms & Maternity OTs have setup functional quality circles and facility level quality tea ms.
  10. Short Term (up to 8 Months)  80% of Labour Room and OT Quality Circles are oriented to latest labour room protocols, quality improvement processes and respectful maternity care (RMC).  50% of deliveries take place in presence of the Birth Companions.  60% of deliveries conducted using safe birth checklist and Safe Surgery Checklist in Labour Room & Maternity OT respectively.  60% of the deliveries are conducted using real-time partograph.  30% increase in Breast Feeding within one hour of delivery  80% labour rooms and Maternity OTs take microbiological samples from defined areas every
  11. Intermediate Term (Up to 12 Months)  30% increase in antenatal corticosteroid administration in case of preterm labour.  30% reduction in pre-eclampsia, eclampsia& PIH related mortality.  30% reduction in APH/PPH related mortality.  20% reduction in new-born asphyxia related admissions in SNCUs for inborn deliveries.  20% reduction in newborn sepsis rate in SNCUs for inborn deliveries.  20% reduction in Stillbirth rate.  80% of all beneficiaries are either satisfied or highly satisfied  60% of the labour rooms are reorganized as per ‘Guidelines for Standardisation of Labour Rooms at Delivery Points’.
  12. Continued  100% compliance to administration of Oxytocin, immediately after birth.  30% improvement in OSCE scores of labour room staff.  100% Maternal death, Neonatal Death audit and clinical discussion on near miss/maternal and neonatal complications  80% Labour Room and OTs are reporting zero stock-outs of drugs and consumables.  Long Term (up to 18 Months)  60% of labour rooms achieve quality certification against the NQAS.  50% of labour rooms are linked to Obstetrics HDU/ICU.  15% improvement in short term & Intermediate targets.  After 18 months, this initiative would be continued through sustained mentoring.
  13. Integration of Safe Delivery App  in LaQshya Safe Delivery Application is a mobile based educational tool to improve the quality of care around birth by empowering skilled birth attendants on basic, emergency obstetric and newborn care  SDA supports improvement of quality of clinical care in LaQshya program by promoting self- learning and acting as a ready reckoner to supplement the skill based trainings like SBA, Dakshata, NSSK etc.
  14. Total safe delivery app status
  15. Achievements & Outcomes  Capacity building is important step towards LaQshya certification. A total of 1,920 health care providers were trained on LaQshya across the 7 states.  Training on Quality Improvement and QI tools was done in 57 % of these training batches.  Most states had separate training for Safe Delivery App as it was introduced later, while some incorporated the same in the ongoing LaQshya trainings.  Nearly 2,000 health care providers have been trained on SDA. (Table 8)
  16. Table :8 health care provider under laqshya
  17. Outcome of project  Support to Aspirational Districts In the 7 Vriddhi supported states, state support included district level focused support for 25 Aspirational districts (Jharkhand 19, Uttarakhand 2, Himachal Pradesh 1, Punjab 2 and Haryana 1).  In Odisha and Chhattisgarh support was provided from state level only. The project supported:  •Baseline assessment of prioritized facilities- 126 LRs and 102 maternity OTs in the ADs of 7 states.  • Mentored LaQshya facilities in the ADs regularly and provided need based inputs provided - training, capacity building, and support for documentation.  Outcome of the project support to medical colleges: 3 labor rooms and 3 maternity OTs received state certification  Outcome: In the 45 Aspirational Districts of the 7 states 60 units - 35 labor rooms and 25 maternity OTs- received state certifications. Of these, of these 25 LRs and 12 maternity OTs have achieved national certification
  18. Document support for vriddhi team
  19. Five Criteria For laQshya Certification
  20. Leveraging PIP FUNDS for Sustaining Interventions  LaQshya Certification LaQshya certification is a tangible outcome. All 7 project states have made considerable progress towards it. In total there have been 132 state certifications of LRs (78) and OTs (54) in the project states. Out of these 86 have been National certified till September 2020 (LR – 51 and OT – 35). State wise details LaQshya certification status is mentioned in Table 9.
  21. Table : LaQshya certification 2020
  22. Challenges & Learnings The Common Challenges Included: • Lack of stable leadership at state and district levels and frequent change in the decision-making cadres slowed down the implementation process. • Over stretched state/district officers with multiple responsibilities led to conflicting priorities at the state and district level. •LaQshya certification required infrastructure and equipment as per quality standards. Timely procurement of equipment and furnishings and infrastructure changes were a huge challenge Coordination between different departments (Maternal health and Child health divisions; MH and State Quality division; NHM and Medical Education and Research) was challenging slowed down inter-departmental activities towards a common goal
  23. Infection Prevention Training  The project developed a standardized presentation on Infection prevention practices.  Telephonic/online platforms were used to train the labor room staff on Infection Prevention.  5149 providers were trained on Infection Prevention from April 2020 – August 2020.
  24. COVID-19 Module for Safe Delivery App  Vriddhi project as a technical partner of Maternity Foundation, provided support for the development of the COVID-19 Module for Safe Delivery App.  The COVID-19 Module was rolled out in the 7 states and orientation was given to staff of LRs in Aspirational District and LaQshya facilities. 2115 users have enrolled as Learners for COVID-19 module in the Vriddhi supported states and 1886 have attained COVID-19 Expert level (As of August 2020).
  25. Client survey satisfactory report  Improving Client Experience in a Medical College in Jharkhand Rajendra Institute of Medical Sciences, Ranchi, Jharkhand reported low scores for availability and quality of food (3.66/5) in the month of July 2019.  The facility conducted several rounds of sensitisation meetings with kitchen staff and catering vendors, and also informed the appropriate authorities. And the score improved to 4.28/5 in the month of November 2019.
  26. Thank you so much for listening