Post on 15-Mar-2018
transcript
Child Health Division, NRHM, Haryana
in technical collaboration with
Rapid
Assessment
9th September, 2013 to 19th
September, 2013
District Hisar
Facility Readiness Assessment for Essential
Newborn Care and Resuscitation
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Table of Contents
Sr. No. Content Page No.
1. Objectives 2
2. Materials and Methods 2
3. List of facilities visited 2-3
4. General findings of District 3-4
4a. Overall Training Status 4
4b. Status of Newborn Corners 4
4c. Availability of equipment and instruments in NBCC 4
4d. Status of NBSUs 5
5. Quantitative findings of facilities 6-10
6. Qualitative findings of facilities
6 a. General Hospital, Hisar 10
6 b. General Hospital, Hansi 11
6 c. General Hospital, Adampur 11
6 d. CHC Aryanagar 12
6 e. PHC Balsmand 12-13
6 f. PHC Chaudhriwas 13
6 g. PHC Gawar 13-14
6 h. PHC Satrod Kalan 14
6 i. CHC Barwala 14
6 j. PHC Agroha 14
6 k. PHC Dhansu 15
6 l. PHC Landri 15
6 m. CHC Mangali 15-16
6 n. PHC Kaimri 16
6 o. PHC Ladwa 16
6 p. PHC Nalwa 16
6 q. PHC Talwandi Rukka 16-17
6 r. CHC Narnaund 17
6 s. PHC Khanda kheri 17
6 t. PHC Mirchpur 17
6 u. PHC Thurana 17
6 v. CHC Siswal 17
6 w. PHC Chuli Bagarian 17-18
6 x. PHC Dobhi 18
6 y. PHC Kajlan 18
6 z. PHC Neoli Kalan 18
6 aa. CHC Sisai 19
6 ab. PHC Data 19
6 ac. PHC Gurana 19-20
6 ad. PHC Umra 20
6 ae. CHC Sorkhi 21
6 af. PHC Baas 21
6 ag. PHC Puthi Saimain 21
6 ah. PHC Puthi Mangal Khan 21
6 ai. CHC Uklana 22
6 aj. PHC Daulatpur 22
6 ak. PHC Hasangarh 22-23
6 al. PHC Pabra 23
6 am. URCH Azadnagar 23
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1. Objectives:
1. Qualitative and quantitative assessment of readiness of our health facilities for essential
newborn care and resuscitation.
2. To assess the quality of essential newborn care provided to each and every neonate
immediately after birth.
3. To understand the existing knowledge, skills, attitudes and practices of the health service
providers.
4. On the job trainings to the service providers on novelties in essential newborn care and
resuscitation.
2. Materials and Methods
1. A structured and tested assessment tool has been used to assess the facilities on 8
parameters viz. facility identification and infrastructure, availability of services, human
resource, Equipment and supplies, Register and client case records, protocols and
guidelines, individual case records, knowledge and practices.
2. Knowledge and skill assessment has been done on the newborn simulators (mannequins).
3. The current and ideal practices in essential newborn care and resuscitation have been
demonstrated to the service providers on the mannequins.
Our teams visited 39 facilities in the district, from 9th September, 2013 to 19th September,
2013, including General Hospitals, all CHCs and PHCs and the delivery huts with monthly
delivery load of 3 or more. Following is the list of facilities visited:
Sr. No. Name of Facility
1. General Hospital, Hisar
2. General Hospital, Hansi
3. General Hospital, Adampur
4. CHC Aryanagar
5. PHC Balsmand
6. PHC Chaudhriwas
7. PHC Gawar
8. PHC Satrod Kalan
9. CHC Barwala
10. PHC Agroha
11. PHC Dhansu
12. PHC Landhri
13. CHC Mangali
14. PHC Kaimri
15. PHC Ladwa
16. PHC Nalwa
17. PHC Talwandi Rukka
18. CHC Narnaund
19. PHC Khanda kheri
20. PHC Mirchpur
21. PHC Thurana
22. CHC Siswal
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23. PHC Neoli Kalan
24. PHC Kajlan
25. PHC Dobhi
26. PHC Chuli Bagarian
27. CHC Sisai
28. PHC Data
29. PHC Gurana
30. PHC Umra
31. CHC Sorkhi
32. PHC Puthi Saimain
33. PHC Puthi Mangal Khan
34. PHC Baas
35. CHC Uklana
36. PHC Daulatpur
37. PHC Hasangarh
38. PHC Pabra
39. URCH Azadnagar
3. The findings of district Hisar in general are as follows:
• Well established referral linkages at the time of delivery (Higher centers are
catering mainly high risk deliveries).
• Availability of staff (including medical officers) and attendants (Nursing staff) in
most of the facilities.
• New born care corners (NBCC) established in almost all the labour rooms.
• Availability of reasonable number of trained staff in NSSK and IMNCI.
• At birth immunization in many facilities.
• Availability of resuscitation equipment in many facilities.
• PHCs with availability of generators and 24*7 backup supply.
• Availability of running water and toilets in the facilities.
• Registers and records maintained in most of the facilities (Case sheets with
uniformly printed formats).
• Availability of Gynecologists in SDHs and CHCs.
• Many birth attendants not trained in SBA.
• Hand washing stations not appropriate for effective hand washing. Effective hand
washing before delivery not followed.
• Simplified Partographs not available in many facilities.
• Partographs maintained in many facilities but method is not correct and in most
cases these are filled after delivery for record completion.
• Autoclave available but not used in some facilities.
• Home deliveries in some areas of the district due to unavailability of 24*7
services in some PHCs.
• Birth preparedness before delivery not done in some facilities.
• Labour room protocols for infection prevention not followed in routine.
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• Case sheets do not have records of essential newborn care.
• Suction of every new born in practice despite good cry.
• Immediate cord cutting in practice.
• Infection prevention and hygiene protocols for labour room and NBCC are not
followed in majority of the facilities.
• Bag and Mask used for resuscitation. Chronology of resuscitation is not clear
(PSSR not followed). Steps are not in chronological order (Resuscitation
equipment are not available)
• Use of Bag and Mask not appropriate.
• Regular refresher trainings needed for resuscitation.
• AMTSL practices are not followed in some facilities.
• Skin to skin contact not in practice.
• Use of Radiant Warmer and separation of every newborn from mother is in
practice.
• Skills of essential newborn care lacking.
• Immediate drying not followed in many facilities
• Management of low birth weight babies not done as per protocols
4 a. Overall Training Status
Sr. No. No. of Birth attendants SBA NSSK IMNCI
1. 204 113 167 135
4 b. Status of Newborn Corners
Newborn Corners
with Radiant
Warmer
Newborn
Corners with
200 W bulb
Total NBCCs
Established
NBCCs still not
established
36 (39) (No labour
room in Mirchpur)
19 37 (18 with both
Bulb and warmer)
One (Recently shifted to
new building URCH
Azadnagar)
4 c. Availability of equipment and instruments in NBCCs (n=39)
Sr. No. Equipment/Instrument Available (No. of
Facilities)
Not available (No.
of Facilities)
1. Self-Inflating Bag 39 0
2. Mask Size ‘1’ 38 1(Gawar)
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3. Mask Size ‘0’ 35 (4) Choudhriwas
GH Hisar (LR)
Talwandi rukka
Daulatpur
4. Shoulder Roll 38 1
5. Suction Catheter 37 2 (Pabra and Sisai)
6. Disposable Mucus Extractors 37 2 (Puthi Samain,
Suryanagar)
7. Suction Machine 39 0
8. Oxygen Cyinder 37 2 (URCH Azadnagar
and Suryanagar)
9. Baby Sheets 38 1 (Balsamand)
10. NBCC at appropriate place 33 6 (changes suggested
on site)
4 d. Status of Designated Newborn Stabilization Units (NBSUs)
Sr. No. Name of
Institution
Status Functionality No. of Radiant
Warmers
No. of
Phototherapy
Units
1. SDH Hansi Established Not Functional 1 1
2. CHC Barwala Not
Established
NA Only in NBCC 0
3. CHC Mangali Not
Established
NA Only in NBCC 1
4. CHC Uklana Not
Established
NA Only in NBCC 1
5. CHC Aryanagar Not
Established
NA Only in NBCC 1
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4. Quantitative Analysis of various facilities (n= 37)
Name Of
Facility Infrastructure
Delivery And
Newborn Care
Services
Essential Drugs,
Equipment And
Supplies
Protocols And
Guidelines
Knowledge
About
Infection
Prevention
Provider
Knowledge
And Skills
Registers
And
Client
Case
Records
Facility’s
Overall
Average
CHC Barwala 85 78 87 80 57 66 75 75
PHC Chuli
Bagrian 69 89 79 70 57 70 75 73
PHC Landri 79 83 72 70 71 72 61 73
PHC Nalwa 98 89 77 50 71 46 69 71
PHC Putty
Mangal Khan 75 89 82 70 71 39 67 71
CHC Mangali 67 72 72 70 57 65 73 68
PHC Khanda
Kheri 88 78 80 60 57 54 58 68
GH Hisar 63 89 84 70 57 59 50 67
GH Hansi 67 89 80 70 57 52 56 67
CHC
Narnaud 71 72 74 60 57 66 66 67
SDH
Adampur 87 83 74 80 29 61 50 66
PHC Ladwa 75 83 79 80 29 55 59 66
CHC Sorkhi 79 89 71 70 43 49 56 65
PHC
Neolikalan 81 83 74 60 43 46 62 64
PHC Sisai 81 89 60 60 43 61 49 63
PHC Agroha 65 78 76 80 29 57 55 63
PHC Gurana 77 83 72 90 14 53 47 62
PHC Kaimri 81 78 66 70 43 46 52 62
Score 75% and Above Score 51% to 74% Score 50% and less
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CHC Arya
Nagar 81 89 79 60 14 48 61 62
PHC Bass 63 89 81 60 29 39 66 61
PHC Dobi 42 83 74 80 43 45 57 61
DISTRICT
AVERAGE 72 82 73 64 36 51 49 61
PHC Datta 65 83 70 90 14 50 47 60
PHC Satrod
Kalan 52 78 79 60 43 55 50 60
PHC Dhansu 69 83 68 60 29 48 56 59
PHC Kajlan 48 83 80 50 29 57 57 58
PHC Pabra 73 83 60 40 43 50 52 57
PHC
Hassangarh 88 78 64 50 29 37 41 55
PHC
Puthisamain 75 83 73 60 29 31 36 55
PHC Umra 67 72 73 60 29 46 28 54
CHC Uklana 71 94 70 50 0 44 46 54
PHC
Daulatpur 69 83 60 50 14 46 48 53
PHC
Talwandi 77 83 60 40 14 43 51 53
PHC
Balsamand 62 72 61 60 29 45 36 52
PHC Gawar 75 72 65 60 14 50 6 49
PHC
Chaudhariwas 71 67 66 60 29 50 0 49
PHC Thurana 79 78 72 60 0 33 7 47
URCH Azad
Nagar 58 78 73 60 0 40 0 44
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Graph 1. Status of Infrastructure (n=37)
Graph 2. Scores of infection prevention knowledge in providers (n=37)
98
88 88 87 8581 81 81 81 79 79 79 77 77 75 75 75 75 73 72 71 71 71 69 69 69 67 67 67 65 65 63 63 62
5852
4842
0
20
40
60
80
100
717171
57575757575757
4343434343434336
2929292929292929292929
141414141414
0 0 00
20
40
60
80
100
Knowledge of Infection Prevention
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Graph 3. Status of Registers and Client Case record maintenance (n=37)
Graph 4. Availability of Essential Drugs, Equipment and Supplies (n=37)
75 75 7369 67 66 66
62 61 61 59 58 57 57 56 56 56 5552 52 51 50 50 50 49 49 48 47 47 46
4136 36
28
7 60 0
0
20
40
60
80
100
Registers and Client Case records
8784 82 81 80 80 80 79 79 79 79 77 76 74 74 74 74 73 73 73 73 72 72 72 72 71 70 70 68 66 66 65 64
61 60 60 60 60
0
20
40
60
80
100
Essential Drugs, Equipment And Supplies
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Graph 5. Status of skills in essential newborn care and resuscitation (n=37)
5. Facility wise Qualitative Findings
a. GH Hisar
All staff nurses not trained in SBA, IMNCI and F-IMNCI.
Injection Dexamethasone not available
Glucose 5% and Ringer’s lactate not available
Injection Vitamin K not available and not administered.
Toilet not available in the labour room.
Partograph not filled regularly.
Baby weight not mentioned on new born case sheets.
Record of birth asphyxia and essential new born care not available
All new born having signs of birth asphyxia are directly referred to SNCU for further
management, So no further record of such new born is not available in the labour
room.
Recommendations
Arrange for trainings of staff nurses.
Make all the essential and life-saving drugs available.
Govt. of India has recommended injection vitamin K for all newborns. Make injection
vitamin K available and ensure its administration to every newborn within first hour
of birth (1mg for babies >1000 gm and 0.5mg for babies weighing <1000 gm, IM in
antereo-lateral aspect of mid-thigh.).
Maintain record of essential newborn care and birth asphyxia in the case sheets.
7270
66 66 6561 61
59 57 5755 55 54 53 52 51 50 50 50 50 49 48 48
46 46 46 46 46 45 45 44 4340 39 39
3733
31
0
20
40
60
80
100
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b. GH Hansi
Very well maintained labour room with established newborn corner.
NBCC is also established in OT with 200 W bulb.
Infection prevention protocols are not followed as per guidelines.
All the oxygen cylinders are without humidifiers and flow-meters.
Newborn Stabilization Unit (NBSU) is not established.
Knowledge of staff nurses about essential newborn care and resuscitation is average.
Skills of all the staff nurses about essential newborn care and resuscitation are below
average and needs great improvement.
Recommendations
Follow infection prevention protocols as per guidelines.
Get humidifiers and flow-meters attached to oxygen cylinders in labour room and OT.
Establish and functionalize NBSU in the hospital. Train at least two nurses for
Facility Based Newborn Care (FBNC) for smooth functioning of NBSU.
c. SDH Adampur
Separate septic and aseptic labour room available.
1 phototherapy machine available but not in use.
2 radiant warmers available.
Infrastructure is underutilized
11 staff nurses available, only 4 of which are SBA trained
Rusted delivery instruments in labour room
Shoulder roll not available
Practice of immediate cord cutting
Resuscitation skills lacks chronology
Vitamin K not in practice
Documentation of essential newborn care is not being done
Partographs are not being filled
Infection prevention protocols not being followed.
Recommendations
Arrange for trainings of staff nurses.
Establish and functionalize NBSU.
Train at least two nurses for Facility Based Newborn Care (FBNC) for smooth
functioning of NBSU.
Govt. of India has recommended injection vitamin K for all newborns. Make injection
vitamin K available and ensure its administration to every newborn within first hour
of birth (1mg for babies >1000 gm and 0.5mg for babies weighing <1000 gm, IM in
antereo-lateral aspect of mid-thigh.).
Maintain record of essential newborn care and birth asphyxia in the case sheets.
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d. CHC Arya Nagar
Hand washing station is not appropriate.
Infection prevention in labour room needs improvement.
Notes regarding baby need to be mentioned in case sheets.
Skin to skin contact should be made during delivery for temperature maintenance
naturally.
Cord should be cut with new blade every time.
Immediate Breast feeding should be done.
Vitamin K should be administered at birth.
Recommendations
Make hand washing station appropriate as suggested during visit.
Follow infection prevention protocols as per guidelines.
Maintain record of essential newborn care and birth asphyxia in the case sheets.
e. PHC Balsamand
Home deliveries are prevalent in the area. Most of the deliveries are being conducted
at home by a trained birth attendant (Dai). There are many reported cases of still birth.
Private RMP Doctors are also prevalent in the area
No separate PNC ward is available.
Out of three staff nurses posted none is trained in SBA. All staff nurses not trained in
F-IMNCI.
Vitamin K not administered to the new born before discharge
At birth immunization not done before discharge (Only zero polio is given).
Baby cloth not available
Inj Vitamin K not administered to the new born
Normal saline inj. Epinephrine not available
Tab Folic acid not available.
Baby botes not available in records.
GPLAD not mentioned in case sheets.
Injection oxytocin is given to every new born after delivery.
Low birth weight new born (<1800gm) are not referred to GH/SNCU.
Infection prevention protocols not followed.
Autoclave not available and not used
Knowledge regarding immediate care to new born within one hour after delivery need
improvement.
Partographs are filled but just for record completion and most of them are filled after
delivery.
Sign and symptoms of infections in newborn, low birth weight baby’s management
knowledge need up-gradation.
Knowledge regarding the signs of birth asphyxia and management thereafter need
hand holding support from the Medical officer in-charge.
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Recommendations
Improve institutional facilities and services to curtail home deliveries. Motivate
people for institutional deliveries and benefits associated.
Arrange for trainings of staff nurses.
Start administering BCG-birth dose, Hepatitis B birth dose and OPV-0 and injection
vitamin k to every newborn.
Make all the essential and life-saving drugs available.
Follow infection prevention protocols as per guidelines.
Promote peer learning and refresher trainings to improve knowledge of birth care
providers.
f. PHC Chaudhariwas
Very well equipped labour room but only one delivery in past six months.
Newborn corner not established in labour room. Radiant warmer or 200 W bulb as a
source of heat, baby face mask of size ‘0’ and shoulder roll not available.
Hand washing area is not appropriate. Though there are elbow taps but are placed
very low which hinders effective hand washing.
Knowledge of staff nurse about essential newborn care and resuscitation is below
average and holds scope for improvement.
Skills of staff staff nurse about essential newborn care and resuscitation are below
average.
Recommendations
Increase delivery load to justify infrastructure and equipment.
Establish NBCC as discussed during the visit.
Improve hand washing stations as discussed during visit to ensure effective hand
washing.
Promote peer learning and refresher trainings to improve knowledge of birth care
providers.
g. PHC Gawar
Equipped labour room but only 5 deliveries in past 6 months.
Newborn corner established with all necessary equipment.
Baby face mask of size ‘1’ is not available.
Knowledge of staff nurse about essential newborn care and resuscitation is below
average and holds scope for improvement.
Skills of staff staff nurse about essential newborn care and resuscitation are below
average.
Recommendations
Increase delivery load to justify infrastructure and equipment.
Improve hand washing stations as discussed during visit to ensure effective hand
washing.
Provide baby face mask of size ‘1’ in NBCC.
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Promote peer learning and refresher trainings to improve knowledge of birth care
providers.
h. PHC Satrod Kalan:
All newborns were being shifted to NBCC.
Milking of cord was in practice.
Cord cutting was being done just after delivery of newborn.
Bed head tickets were partially filled.
AMBU bag Autoclave is not in practice.
Recommendations:
There is no need to shift all newborns to NBCC. Only those who require special care
i.e. basic resuscitation or resuscitation with AMBU bag are required to be shifted.
Cord should be cut with sterile blade, milking of cord is not recommended and cord
cutting should be done with a gap of 1 to 3 minutes after birth.
i. CHC Barwala
Facility designated for NBSU during visit space identified and communicated to SMO
need to establish NBSU as soon as possible
NBCC established at labour room need to keep a shoulder roll (0.5 to 1 inch
diameter), baby sheets are to be arranged as per delivery load (for 30 delivery per
month 6 to 10 sheets required )
Essential Newborn Care and Resuscitation knowledge inadequate at facility during
visit we took session on this SMO should ensure same knowledge should be in
practice.
Hygiene should be maintain in labour room area during visit we took session about
infection prevention and hygiene facility in charge should ensure
implementation/practice
Delivery and Newborn registers provided to facility should fill all delivery and its
events in it.
Every newborn should room in with mother.
j. PHC Agroha:
Unclean machintosh available on delivery table.
Inappropriate size of shoulder roll was available at radiant warmer.
PNC ward was not clean which provides uncongenial environment for mother and
newborn.
Autoclaving of AMBU Bag and masks is not in practice.
Delivery table cushion (bed) plastic cover is torn. Provide new cushion for delivery
table.
Recommendations:
The shoulder roll should be made of 1-1/4 inch broad for appropriate support.
AMBU bag should be autoclaved on regular basis.
Elbow tap should be made available for labor room so that proper hand washing
techniques should be followed.
Machintosh once used should be cleaned after every delivery and if torn or cut, should
be discarded off.
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k. PHC Dhansu
Congested labour room and NBCC.
All essential equipment available and functional at NBCC.
Good record keeping. Case files complete in most senses except notes of immediate
newborn care.
Infection prevention seems highly compromised and not practiced as per guidelines.
Knowledge of staff nurses about essential newborn care and resuscitation is average.
Skills of all the staff nurses about essential newborn care and resuscitation are below
average and needs great improvement.
Recommendations
Start writing notes on essential newborn care as discussed during the visit.
Improve infection prevention by following guidelines.
Promote peer learning and refresher trainings to improve knowledge of birth care
providers.
l. PHC Landri
Well maintained delivery room with appropriately placed NBCC.
Skills of staff nurses are good about –
o Essential new born care.
o Identification of Birth Asphyxia.
o Process of Resuscitation.
Well maintained case sheets available with appropriate case notes.
Infection prevention and hygiene protocols are not followed for NBCC.
Recommendations
Maintain sterile environment at NBCC.
Sterilize Bag and Mask regularly.
Suction machine bottles should contain 3% phenol or 5% Lysol.
m. CHC Mangali
CHC having space constraint so no properly designated PNC and ANC room.
No designated area for boiling and autoclaving, duty room for nurses and utility
rooms for linen.
Injection Adrenaline not available.
Infection prevention protocols not followed regularly.
One staff nurse not trained in SBA, NSSK and two are not trained in IMNCI.
Skills for resuscitation need improvement.
Recommendations
Follow infection prevention protocols as per guidelines.
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Arrange for trainings of staff nurses for SBA, NSSK and F-MNCI.
n. PHC Kaimri
Well maintained labour room with appropriate NBCC with all necessary equipment.
Apparently there is no birth preparedness before delivery.
Knowledge of staff nurses about essential newborn care and resuscitation is average.
Skills of staff nurses about essential newborn care and resuscitation are below
average.
Record keeping in registers and case sheets is good but baby notes need improvement
and notes on essential newborn care are to be incorporated in the registers.
Recommendations
Birth preparedness is integrated part of delivery process. Improve birth preparedness
to avoid eleventh hour hassles.
Start writing notes of essential newborn care on case sheets as discussed during the
visit.
Promote peer learning and arrange for refresher trainings to improve knowledge and
skills of staff nurses.
o. PHC Ladwa
NBCC established but not on proper place during visit we identified place need to
install NBCC on identified place
Suction of every newborn in spite of well cry and breath need to discourage
Every newborn kept at NBCC need to discourage for normal newborn and mother
Shoulder role need to replace / prepare as directed during visit
Unhygienic blood stained labour table and mechantose need to take immediate action
Bed heads sheets records were inadequate required to capture delivery and newborn
care events in detail
p. PHC Nalwa
Report not received yet.
q. PHC Talwandi
One staff nurse is not trained in NSSK.
Infection prevention and hygiene protocols not followed.
Immediate cord cutting is in practice.
Skin to skin contact is not maintained.
Every new born is shifted to radiant warmer.
Recommendations
Ensure cord cutting between 1-3 minutes after delivery.
Ensure skin to skin contact is maintained immediately after every normal delivery to
prevent hypothermia.
Ensure immediate breastfeeding after every normal delivery.
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Ensure infection prevention and hygiene.
r. CHC Narnaud
Mechanical baby weighing scale not working properly.
Flow meter and pressure valve of oxygen cylinder in labour room is not working.
Normal saline not available
Case records need improvement
Partographs are not filled regularly and need improvement.
Skills for resuscitation and essential new born care need improvement.
Injection Vitamin K not administered.
At birth immunization not done.
Recommendations
Start administering BCG, Hepatitis-B birth doses, OPV-0 dose and injection vitamin
K to every newborn.
Maintain case records and patograph of each delivery properly as discussed during
visit. Also, write detailed notes on essential newborn care and resuscitation.
s. PHC Khanda Kheri
Suction of every newborn in spite of good cry and breathing.
Practice of keeping every newborn at NBCC.
Shoulder roll needs replacement. Prepare as suggested during visit.
Administration of antibiotic to mother before every delivery need to discourage for
normal mother
Immediate cord cutting is usual practice at facility. There is need to discourage this
practice and to promote delayed cord cutting (between 1 to 3 min after birth).
Recommendations
Discourage suction of every newborn. Suction is required in cases where signs of
asphyxia are apparent.
Only those babies are to be taken to NBCC who require resuscitation. Practice skin to
skin contact between mother and baby in all cases where vitals of both are WNL.
t. PHC Mirchpur
There is no labour room in this PHC.
u. PHC Thurana
Report not received yet.
v. CHC Siswal
Report not received yet.
w. PHC Chuli Bagrain
NBCC well established with well displayed IEC and equipment uses guidelines
Expired drug mechanism well followed.
18 | P a g e
Office order displayed for routine immunization in labour room
Well maintained delivery and newborn records
Well maintained referral register
Shoulder roll needs replacement. Prepare as suggested during visit.
Milking of cord is usual practice at facility. Milking of cord is not recommended these
days, so, please discourage this practice.
x. PHC Dobi:
Vitamin K, Hep B, and BCG at birth doses were not being given.
Shoulder roll was present, but was not of appropriate size.
AMBU Bag autoclave was not in practice.
Bed head tickets does not contain all vital events, at places it was partially filled.
Recommendations:
Birth doses of Vit K, Hep B, OPV, and BCG should be given to all newborns with a
mention in bed head tickets and discharge slip as well.
The shoulder roll should be made of 1-1/4 inch broad for appropriate support.
AMBU bag should be autoclaved on regular basis.
y. PHC Kajlan
Suction of every newborn in spite of good cry and breathing.
Practice of keeping every newborn at NBCC.
Shoulder roll needs replacement. Prepare as suggested during visit.
Administration of antibiotic to mother before every delivery need to discourage for
normal mother
Immediate cord cutting is usual practice at facility. There is need to discourage this
practice and to promote delayed cord cutting (between 1 to 3 min after birth).
Recommendations
Discourage suction of every newborn. Suction is required in cases where signs of
asphyxia are apparent.
Only those babies are to be taken to NBCC who require resuscitation. Practice skin to
skin contact between mother and baby in all cases where vitals of both are WNL.
z. PHC Neolikalan:
Vit K at birth dose is not given.
Shoulder roll was not of proper size.
All staff nurses were NSSK trained, but unable to show required skills for
resuscitation.
Recommendations:
At birth dose of Vitamin K should be given to all newborns.
The shoulder roll should be made of 1-1/4 inch broad for appropriate support.
Regular monitoring and peer learning is recommended to improve the skills.
19 | P a g e
aa. CHC Sisai:
Very good knowledge of staff nurses regarding ANC checkup, Detection of danger
sign in newborn, management of 3rd stage of labor, newborn routine care for normal
delivery.
Birth preparedness for delivery and newborn care found to be adequate.
Average hospital stay of delivery women is approximately 12 hours.
Well maintained NBCC.
Timely disinfection of instruments and disposal of waste as per guidelines are
followed.
Recommendations:
Housekeeping protocols are required to be followed.
Pressure of suction machine at NBCC should be maintained between 80 to 100
mmHg for neonatal suction.
ab. PHC Datta
Separate breast feeding room available with a chair and breast feeding kit. This is a
very good initiative
Record maintenance poor. Partographs are filled incompletely and inaccurately
Documentation of essential newborn care is lacking
Documentation of baby resuscitated with bag and mask not available
Disinfection of bag and mask is not in practice
Practice of immediate cord cutting
Resuscitation skills lack chronology.
Double gloving not in practice.
NBCC well established.
Recommendations
Improve record keeping. Maintain partograph properly. Start writing notes on
essential newborn care in case sheets.
Follow infection prevention protocols as per guidelines.
Practice delayed cord cutting (between 1 to 3 minutes of birth).
ac. PHC Gurana
Immunization of newborn in practice
Double gloving not in practice
Practice of separating every newborn from mother despite good cry.
Practice of milking of cord
Practice of immediate cord cutting
Resuscitation skills lacks chronology
Record keeping poor. Partographs incompletely and inaccurately filled
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Documentation of essential newborn care not being done
Bag and mask not being disinfected regularly
Staff nurse does not know the dose of Vitamin K.
Recommendations
Improve record keeping. Maintain partograph properly. Start writing notes on
essential newborn care in case sheets.
Follow infection prevention protocols as per guidelines.
Practice delayed cord cutting (between 1 to 3 minutes of birth).
Govt. of India has recommended injection vitamin K for all newborns. Make injection
vitamin K available and ensure its administration to every newborn within first hour
of birth (1mg for babies >1000 gm and 0.5mg for babies weighing <1000 gm, IM in
antereo-lateral aspect of mid-thigh.).
ad. PHC Umra
Tap in the hand washing area is not elbow operated.
One staff nurse not trained in SBA and IMNCI.
Injection hydrocortisone not available
Need improvement in knowledge regarding care of low birth weight and premature
baby
Knowledge regarding sign of infection prevention and management need
improvements.
Knowledge regarding sign and symptoms of birth asphyxia and management
thereafter need regular refreshers.
Newly recruited staff nurses are not trained in SBA, NSSK and IMNCI.
Partographs are not filled regularly.
Infection prevention protocols are not followed
Injection Vitamin K not administered
Recommendations
Arrange for trainings of staff nurses.
Make all the essential and life-saving drugs available.
Govt. of India has recommended injection vitamin K for all newborns. Make injection
vitamin K available and ensure its administration to every newborn within first hour
of birth (1mg for babies >1000 gm and 0.5mg for babies weighing <1000 gm, IM in
antereo-lateral aspect of mid-thigh.).
Maintain record of essential newborn care and birth asphyxia in the case sheets.
Promote peer learning and arrange for refresher trainings to improve knowledge and
skills of staff nurses.
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ae. CHC Sorkhi
Well established labour room. Newborn corner established with all necessary
equipment.
Hand washing station is not appropriate and taps are low in height.
As per the knowledge and skill test of the staff nurses it is apparent that there is
practically no birth preparedness before delivery.
Knowledge of two staff nurses about essential newborn care and resuscitation is
average and of one staff nurse is below average.
Skills of all the staff nurses present for essential newborn care and resuscitation are
below average.
Record keeping in registers and case sheets is generally good but case sheets lack
record of essential newborn care.
Recommendations
Birth preparedness is integrated part of delivery process. Practice meticulous birth
preparedness to avoid eleventh hour hassles.
Maintain record of essential newborn care and birth asphyxia in the case sheets.
Promote peer learning and arrange for refresher trainings to improve knowledge and
skills of staff nurses.
af. PHC Bass
Report not received yet.
ag. PHC Puthisamain:
Sufficient numbers of baby sheets were not available, and were not autoclaved.
Machintosh sheet was blood stained and with lots of cracks on it.
Disposable mucus sucker was not available.
Shoulder roll was not as per required height.
Partograph was being filled in wrong manner.
Recommendations:
Baby sheets should be available in sufficient quantity, which should be autoclaved
before use.
Machintosh sheet should be changed on regular basis as it gets any permanent stain or
any crack. It should be wiped out and washed after every use or delivery.
Disposable mucus sucker is desired for suction and should be made available.
Shoulder roll was made by team member, but should be cleaned on regular basis and
needs to be made as per direction after washing / autoclave.
Partograph should be filled in correct manner.
ah. PHC Puthi Mangal Khan
Report not received yet.
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ai. CHC Uklana
Immediate cord cutting is in practice.
Skin to skin contact is not maintained.
Every new born is shifted to radiant warmer.
Staff nurses have average skills for neonatal resuscitation.
Infection prevention and hygiene protocols are not followed.
Recommendations
Ensure cord cutting between 1-3 minutes after delivery.
Ensure skin to skin contact is maintained immediately after every normal delivery to
prevent hypothermia.
Ensure immediate breastfeeding after every normal delivery.
Ensure infection prevention and hygiene.
aj. PHC Daulatpur
One staff nurse is not trained in NSSK.
Zero size mask not available.
Staff nurses have average knowledge about essential new born care.
Immediate cord cutting in practice.
Shoulder roll not available.
Staff nurses have poor skills for neonatal resuscitation.
Recommendations
Ensure availability of all equipment for NBCC. Unavailability of the same may cause
neonatal death.
Skills of staff nurses need to be improved through regular monitoring and
handholding.
ak. PHC Hassangarh
Hand washing station not available.
Oxytocin being used for augmentation of labour.
Rusted delivery instruments.
Staff nurse given additional charges of Death/birth, cold chain. Only 2 staff nurses
available.
Staff nurse available at night is not SBA, NSSK trained.
Double gloving not in practice.
Practice of separating every newborn from mother despite good cry.
Practice of milking of cord.
Practice of immediate cord cutting.
Resuscitation skills lack chronology.
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Record keeping poor. Partographs are not being filled.
Documentation of essential newborn care not being done.
Infection prevention practices are not being followed.
Recommendations
Make appropriate hand washing station.
Arrange for trainings of staff nurses.
Discourage milking and immediate cutting of cord. Cut cord between 1 to 3 minutes
of birth.
Follow infection prevention protocols as per guidelines.
Keep appropriate record of essential newborn care as discussed during the visit.
al. PHC Pabra
Report not received yet.
am. URCH 14 Azadnagar
Suction of every newborn in spite of good cry and breathing. There is need to
discourage this practice.
After delivery every newborn is taken to NBCC. There is need to discourage this
practice. Practice skin to skin contact between mother and baby if vitals of both are
WNL.
Shoulder roll needs replacement. Prepare shoulder roll as suggested during the visit.
Milking of cord is usual practice at facility. Discourage milking of cord.
Immediate cord cutting is usual practice for every newborn need to cut cord within 1
to 3 minute in case of good cry and breathing in newborn.
Augmentation of labour by oxytocin is usual practice at facility. Discourage this
practice.
Need to promote Skin to skin contact for normal newborn and stable mother.