Table 1.
Quality Improvement interventions classified according to the Donabedian framework
| Structures | Process | Outcomes | |
|---|---|---|---|
| Structural | Lack of space dedicated to the KMC | Creation of two new rooms with six extra beds for KMC, for a total of fifteen beds | Reduction of neonatal mortality due to asphyxia, prematurity and sepsis |
| No bathroom for the mothers | Rehabilitation of one bathroom for the patients and one for the NICU staff | ||
| No mosquito nets on beds | Painting walls, repairing windows and installation of impregnated mosquito nets for each KMC bed | ||
| Equipment | Lack of equipment and supplies | Oxygen concentrators with implementation of pulse oximeter utilization and technical maintenance | |
| Glucometer and point-of-care testing for C-Reactive Protein and technical maintenance | |||
| UVB light for phototherapy and technical maintenance | |||
| Infusion pumps and technical maintenance | |||
| First and second line antibiotics | |||
| Clinical | Lack of standardization of the quality of work between different doctors | Creation of diagnostic-therapeutic protocols for the main neonatal diseases (sepsis, dyspnea, prematurity, asphyxia, hypoglycemia, neonatal seizures, enteral feeding) | |
| Lack of internal organization | Monthly meeting with doctors working in the NICU focused on good clinical practice, discussion of case reports, medical issues and protocols | ||
| Scheduled visiting hours, ward access permitted only to internal personnel and families | |||
| Organized staff shifts | |||
| Payment of an extra shift performed by a nurse during the afternoon and night to obtain a nurse/patient ratio of 1/15 compared to 1/30 of the pre-intervention | |||
| Lack of basic hygienic rules | Meeting twice a month with nurses and NICU’s staff on hand washing, cup feeding, newborn cleaning, water purification for hand washing and formula milk preparation | ||
| Lack of theoretical knowledge and technical skills about the neonatal resuscitation in the delivery room | Organization of a neonatal resuscitation course for the midwives on January 2014 with a Portuguese-speaking certified neonatologist midwives | ||
| On-the-job training by a certified local midwife a week per month | |||
| Weekly meeting with the midwives with discussion of one clinical case | |||
| Installation of a camera in the delivery room and in the operating room to record 24/7 the neonatal resuscitation made by the midwives working in the Obstetrical Department to evaluate their performances | |||