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Dr. Sakhi John
Dr. Smriti Arora


Early skin-to-skin contact (SSC), Early initiation of breast feeding (EIBF), Nurses, Newborn, Plan-Do-Study-Act (PDSA).


Background: In the delivery room, immediate infant care techniques including skin-to-skin contact (SSC) and early breastfeeding initiation (EBFI) offer several advantages, including improved survival. The techniques have not been extensively embraced despite the evidence. Through a series of plan-do-study-act (PDSA) cycles, we employed a point-of-care quality improvement (QI) to adopt and maintain these two immediate infant care procedures in our delivery room over a period of two years.

Aims: The aim of the study was to assess the effectiveness of Nurse Led Mentoring using Quality improvement methodology for health care workers in improving maternal and neonatal outcomes at selected tertiary care hospitals in Delhi.

Maternal outcome: It refers to initiation of breast feeding in first hour after delivery with no or minimum complication of third stage of labor.

Neonatal outcome: It refers to skin-to-skin touch of mother and receiving breast feeding within first hour of delivery.

Methodology:  A root cause analysis was conducted by a group of obstetricians, nurses and nursing students to determine the potential causes of an increase in early initiation of breastfeeding (EIBF). The areas of improvement in delivering maternal and neonatal care were assessed by using standard tool NQAS (National Quality Assurance Standard. The group made use of fish bone analysis and process flow mapping. In order to enhance the current data, several modifications could be implemented via successive Plan-Do-Study-Act (PDSA) cycles.

Results: A total 10 numbers of nurses participated in this QI study, which conducted from November 2021 to May 2022. Over the course of the study, SSC significantly increased from a baseline of 0% to 68% and EIBF from a baseline of 38% to 82%. This study discovered a 44% major gap closure in EIBF and 68% in SSC.

Conclusion: The Nurse Led Intervention's effectiveness in enhancing maternal and newborn outcomes has thus been shown. Making skin-to-skin contact with newborns shortly after delivery and EIBF as a part of pre-natal preparation and recording by a QI project might be continued without the need for any extra resources.

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