Transfer to Home of Low-Birth-Weight Infants in Kangaroo Mother Care (KMC)-A Point of Care Quality Improvement (POCQI) Approach.

Abstract

Background: Kangaroo mother care (KMC) is the standard of care for low birth weight (LBW) infants. Transport of a stable LBW infant from the hospital to home at discharge poses a significant risk of hypothermia. Though this risk can be mitigated by KMC, LBW infants are not routinely transferred back to KMC at the time of discharge.

Objective: Aim: To improve transfer to the home of LBW infants in KMC at the time of discharge from the baseline of < 1% to 50% in 6 weeks with the point of care quality improvement (POCQI) approach.

Methods: LBW infants discharged home during the study period were enrolled. The quality team (QI) team explored barriers to back transfer in KMC through fishbone analysis. Four plan-do-study-act (PDSA) cycles were implemented (Policy of transport KMC, ambulation in KMC during hospital stay, root cause analysis of missed babies, and Reinforcement of practice using posters). Acceptability was defined as reaching the destination in KMC and efficacy as euthermia at the destination.

Results: Of 59 LBW infants discharged home during the study period, 89% were discharged in transport KMC. The acceptability was 98%; 6% had interruptions during the journey. Efficacy was 88% with a mean temperature of 36.9°C. All parents felt it was a safe method of transport. Mean hours of KMC increased from 4 h prior to the study to 8 h after. The practice was sustained at 74% following the study.

Conclusion: A QI approach improves transfer to the home of LBW infants in KMC. It is a safe, effective, and acceptable mode of transport for LBW infants and aids in maintaining euthermia. However, continuous efforts are needed to sustain this practice.