assessment district rewari - · pdf filethe findings of district rewari in general are as...

Child Health Division, NRHM, Haryana

in technical collaboration with

RAPID

Assessment

7th October, 2013 to 15th October,

2013

District Rewari

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

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 5-9

6. Qualitative findings of facilities

6 a. General Hospital, Rewari 10

6 b. SDH Kosli 10

6 c. CHC Bawal 10

6 d. PHC Kosla 11

6 e. PHC Sangwari 11-12

6 f. PHC Tankri 12

6 g. CHC Gurawara 12

6 h. PHC Dahina 13

6 i. PHC Fathpuri 13

6 j. PHC Jatusana 13

6 k. CHC Khol 13-14

6 l. PHC Bassduda 14

6 m. PHC Siha 14-15

6 n. CHC Meerpur 15

6 o. PHC Baharawas 15

6 p. PHC Dharuheda 16

6 q. PHC Masani 16

6 r. CHC Nahar 17

6 s. PHC Bawwa 17-18

6 t. PHC Guryani 18

6 u. SC Chillar 18-19

6 v. SC Jadra 19

6 w. SC Kapriwas 19

6 x. SC Nangal Sehbazpur 19

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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 24 facilities in the district, from 7th October, 2013 to 15th October, 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, Rewari

2. SDH Kosli

3. CHC Bawal

4. PHC Kosla

5. PHC Sangwari

6. PHC Tankri

7. CHC Gurawara

8. PHC Dahina

9. PHC Fathpuri

10. PHC Jatusana

11. CHC Khol

12. PHC Bassduda

13. PHC Siha

14. CHC Meerpur

15. PHC Baharawas

16. PHC Dharuheda

17. PHC Masani

18. CHC Nahar

19. PHC Bawwa

20. PHC Guryani

21. SC Chillar

22. SC Jadra

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23. SC Kapriwas

24. SC Nangal Sehbazpur

4. The findings of district Rewari in general are as follows:

• Good infrastructure.

• Availability of equipment.

• Availability of doctors and staff nurses.

• Established Newborn Care Corners.

• At birth immunization done in most of the facilities.

• Many birth attendants not trained in SBA, NSSK and F-IMNCI.

• Designated NBSUs not functional.

• Hand washing stations not appropriate for effective hand washing.

• Partographs maintained in many facilities but method is not accurate and filled after

delivery for record completion. Simplified Partographs not available in many facilities

• Autoclave available but not used in some facilities

• Reuse of disposable mucus extractors is in practice.

• Birth preparedness before delivery not done in some facilities.

• Labour room protocols for infection prevention not followed in routine.

• Effective hand washing before delivery not followed.

• Case sheets do not have records of essential newborn care.

• Suction of every new born in practice despite good cry.

• Augmentation of labour by oxytocin is rampant.

• Baby drying and wrapping sheets are not available.

• Cradles are still available in post natal wards (not recommended).

• Skin to skin contact between mother and baby is not in practice.

• Immediate cord cutting in practice.

• Milking of cord still in practice.

• Infection prevention and hygiene protocols for labour room and NBCC are not

followed in majority of the facilities.

• Regular refresher trainings needed for resuscitation. Steps are not in chronological

order (Resuscitation equipment are not available)

• AMTSL practices are not followed in some facilities.

• Use of Radiant Warmer and separation of newborn from mother for every newborn is

in practice.

• Skills of essential newborn care lacking.

• Immediate drying of newborn not followed in many facilities

• Management of low birth weight babies not done as per protocols

4 | P a g e

4 a. Overall Training Status

Sr. No. No. of Birth attendants SBA NSSK IMNCI

1. 93 58 67 60

4 b. Status of Newborn Corners

Newborn Corners with

Radiant Warmer

Newborn

Corners with

200 W bulb

Total NBCCs

Established

NBCCs still not

established

20 4 24 0

4 c. Availability of equipment and instruments in NBCCs (n=24)

Sr. No. Equipment/Instrument Available (No. of

Facilities)

Not available (No.

of Facilities)

1. Self-Inflating Bag 24 0

2. Mask Size ‘1’ 24 0

3. Mask Size ‘0’ 21 3 (PHC Bharawas,

SC Chillar, SC

Nangal Sahbajpur)

4. Shoulder Roll 22 2 (PHC Siha,

Jatusana)

5. Suction Catheter 24 0

6. Disposable Mucus Extractors 19 5 (CHC Nahar,

Bawal, PHC Dahina,

Siha, SC Jadra)

7. Suction Machine 24 0

8. Oxygen Cylinder 21 3

9. Baby Sheets 20 4 (PHC Bawwa,

Kosla, Dharuhera,

Masani)

10. NBCC at appropriate place 22 2

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4 d. Status of Designated Newborn Stabilization Units (NBSUs)

5. Quantitative Results and Scores (>75 Good, 50-75 Average, <50 Poor)

Name of

Facility

Infrastructu

re

Delivery And

Newborn

Care

Services

Essential

Drugs,

Equipment

And

Supplies

Protocols

And

Guideline

s

Knowledge

About

Infection

Prevention

Provider

Knowledg

e And

Skills

Register

s And

Client

Case

Records

Facility’s

Overall

Average

PHC

DAHINA 100 94 73 80 100 71 65 83

PHC

BARAWAS 80 89 71 70 57 59 51 68

PHC

FATEHPURI 72 89 75 70 57 66 47 68

PHC

DHARUHER

A

66 89 74 70 43 61 59 66

PHC

KOSALA 72 89 73 70 43 62 50 65

PHC SIHA 82 83 65 80 43 45 45 63

SC NANGAL

SEHBAJPUR 78 89 79 70 29 48 45 63

CHC NAHAR 76 83 83 50 43 40 55 62

CHC KHOL 72 83 69 60 43 45 56 61

DH REWARI 76 89 71 70 0 38 75 60

DISTRICT

AVERAGE 72 84 68 62 36 48 44 59

Sr. No. Name of

Institution

Status Functionality No. of Radiant

Warmers

No. of

Phototherapy

Units

1. CHC Bawal Established Not Functional 1 1

2. CHC Khol Not

Established

NA Only in NBCC 0

6 | P a g e

SC JADRA 74 83 74 60 43 36 41 59

PHC

DAHINA 100 94 73 80 100 71 65 83

PHC

BARAWAS 80 89 71 70 57 59 51 68

PHC

FATEHPURI 72 89 75 70 57 66 47 68

PHC

DHARUHER

A

66 89 74 70 43 61 59 66

PHC

KOSALA 72 89 73 70 43 62 50 65

PHC SIHA 82 83 65 80 43 45 45 63

SC NANGAL

SEHBAJPUR 78 89 79 70 29 48 45 63

CHC NAHAR 76 83 83 50 43 40 55 62

CHC KHOL 72 83 69 60 43 45 56 61

DH REWARI 76 89 71 70 0 38 75 60

SC JADRA 74 83 74 60 43 36 41 59

7 | P a g e

Graph I. Status of Infrastructure (n=24)

Graph II. Overall Scores of facilities in Facility Readiness (n=24)

100

82 80 78 76 76 76 74 74 74 74 72 72 72 72 70 68 66 66 66 66 6460 58

54

0

20

40

60

80

100

83

68 68 66 65 63 63 62 61 60 59 59 58 58 58 57 56 56 56 55 53 53 50 47 44

0

20

40

60

80

100

8 | P a g e

Graph III. Scores of infection prevention knowledge in providers (n=24)

Graph IV. Provider’s knowledge and skills for Essential Newborn Care and Resuscitation

(%) (n=24)

100

57 57

43 43 43 43 43 43 43 43 43

36

29 29 29 29 29 29 29 29

14 14

0 00

20

40

60

80

100

7166

62 61 60 59 56

49 49 48 48 48 47 45 45 45 45 43 40 39 38 37 36 34

26

0

20

40

60

80

100

9 | P a g e

Graph V. Status of Registers and Client Case record maintenance (n=24)

Graph VI. Availability of Essential Drugs, Equipment and Supplies (n=24)

75

65 6359 56 56 56 55

51 50 48 47 47 45 45 45 44 44 41 4137 34

40 0

0

20

40

60

80

100

8379

76 75 75 74 74 73 73 71 71 69 69 68 68 67 67 65 63 61 60 59 5853 53

0

20

40

60

80

100

10 | P a g e

6. Facility wise Qualitative Findings

a. General Hospital, Rewari

Report not available

b. SDH Kosli

• The facility is under serving than its designation and available staff. It is operating

from an old building, soon will be shifted to new building.

• Most of the staff nurses are not trained for SBA, NSSK and IMNCI.

• Baby sheets are not available in adequate number.

• Infection prevention protocols are not followed as per guidelines.

• Knowledge of staff nurses about essential newborn care and resuscitation is

average and holds scope for improvement.

• Skills of staff nurses for essential newborn care and resuscitation is below

average.

Recommendations

• Arrange for trainings of staff nurses.

• Provide sufficient number of baby sheets in labour room (at least 2 sterile sheets per

delivery).

• Follow infection prevention protocols as per GOI guidelines.

• Improve knowledge and skills by peer to peer learning and refresher trainings.

c. CHC Bawal

• Three radiant warmers were available, but only one utilized.

• NBSU designated, but not functional.

• Infection prevention is not in practice for post natal ward and NBCC.

• Case sheets are incomplete, not mentioning gestation weeks for all mothers.

• Vitamin k injection not being given. Birth dose of immunization along with

vitamin k should be administrated to all newborn before discharge from health

facility.

• Iron tablet not avaible at CHC.

Recommendations

• Establish and functionalize Newborn Stabilization Unit.


• Improve knowledge and skills by peer to peer learning and refresher trainings.

• Prepare case sheets to detail and include notes on essential newborn care.

• GOI made it mandatory to administer injection vitamin K to every newborn (1mg to

babies >1500 gm and 0.5 mg for babies <1500 gm birth weight IM in antero-lateral

aspect of mid-thigh). Administer Vitamin K to every newborn with at birth

immunization).

11 | P a g e

d. PHC Kosala

• NBCC established at facility with a radiant warmer, shoulder roll, bag and mask

of both sizes, suction machine and oxygen cylinder.

• Labour room congested.

• Immunization of newborn with zero dose HepB and OPV in practice.

• Practice of separating every newborn from mother despite good cry.

• Practice of immediate cord cutting.

• Practice of re-clamping the cord.

• Double gloving not in practice

• Skin to skin contact not in practice

• Baby sheets are not available

• Case records are not properly maintained. Documentation of essential newborn

care is not done

• Partographs are inaccurately filled.

• Vitamin K is not available.

Recommendations

• Cut cord between 1 to 3 minutes of birth.

• Practice skin to skin contact between mother and baby if the vitals of both are WNL.


• Fill and make proper use of partograph.




immunization).

e. PHC Sangwari


of both sizes, suction machine and oxygen cylinder

• Immunization of newborn with zero dose HepB and OPV in practice.

• Autoclaving of bag and mask in practice but without dismantling it.

• Fumigation of labour room in practice and record keeping of the same is available.

Concerns

• Staff nurse does not know the dose of Vitamin K

• Only 4 baby sheets are available


care is not done

• Partographs are incompletely filled

• Practice of separating every newborn from mother despite good cry

• Practice of immediate cord cutting

• Practice of reclamping the cord

• Double gloving not in practice

• Skin to skin contact not in practice

12 | P a g e

• Knowledge of staff nurse about resuscitation is not in chronological order

• Infection prevention protocols to be followed

Recommendations








immunization).

f. PHC Tankri

Report not available.

g. CHC Gurawda

• Infection prevention and Hygiene protocols are not followed.

o Bottles of Suction apparatus should contain 3% phenol or 5% Lysol.

• Knowledge of staff nurse is poor for providing following services,

o ANC

o Identification of High Risk pregnancies

o Immediate care for new-born

o Identification of Infection/Sepsis in new-born

o Special care for low birth weight new-born

o Identification of Birth Asphyxia

o Neonatal Resuscitation

• Knowledge of staff nurse is average for providing following services,

o Identification of true labour pains

o Monitoring the progress of labour

o Active management of third stage of labour

o New-born shifted to radiant warmer immediately after birth.

o Skin to skin contact not maintained.

Recommendations








immunization).

13 | P a g e

h. PHC Dahina

• Well maintained labour room.

• All the instruments and equipments are available.

• ENCR skills of staff nurses are good.

• Partographs are maintained properly.

• Infection prevention protocols are maintained properly.

• Case files are well maintained with newborn notes.

i. PHC Fathpuri

• Well maintained labour room.

• Vitamin k is not available.

• Suction of every newborn is in practice.

• Partographs need improvement.

• Immediate cord cutting is in practice.

• Disinfection protocols are not followed properly.

• Knowledge of staff nurses regarding ENCR is average. Recommendations

• Provide injection vitamin K for newborns in labour room.

• If the baby breathes and cries well there is no need for suction.

• Fill and use partograph properly to identify any complication during labour process.



• Encourage peer to peer learning to improve knowledge and skills.

j. PHC Jatusana


k. CHC Khol

• Injection vitamin K for newborns is not available.

• There is no birth preparedness before delivery.

• Immediate cord cutting and taking every newborn away from mother is in practice.

• Skin to skin contact between mother and newborn not in practice.


• Case sheets do not have complete record of essential newborn care.

• Filling of partographs need improvement.

• Knowledge of one staff nurse for essential newborn care and resuscitation is good but of

others is below average.

• Skills of staff nurses and ANMs for essential newborn care and resuscitation are below

average.

Recommendations




• Maintain proper case records of mother and newborn (notes on essential newborn

care) in files.


14 | P a g e



l. PHC Bassduda

• Injection vitamin K for newborns is not available.


• Immediate cord cutting and taking every newborn away from mother is in practice.

• Skin to skin contact between mother and newborn not in practice.




• Hand washing station is inappropriate for effective hand washing. Provide proper sink

and elbow taps at appropriate height.

• Baby sheets are not available.

• Shoulder roll is not appropriate.

• Knowledge of staff nurses about essential newborn care and resuscitation is good.

• Skills of staff nurses about essential newborn care and resuscitation are below average

and can be improved by peer learning and continuous supervision.

Recommendations


• Practice proper birth preparedness before each delivery to avoid eleventh hour

hassles.




care) in files.




m. PHC Siha

• Labour room is very congested.

• Hand washing station is inappropriate for effective hand washing. Provide proper

sink and elbow taps at appropriate height.

• Injection vitamin K for newborn is not available.

• Disposable mucus extractors, disposable suction catheters are not available. There

is reuse of suction catheters.

• Shoulder roll not available.


• Immediate cord cutting and taking every newborn away from mother is in

practice.




15 | P a g e

Recommendations


• Provide disposable mucus extractors, suction catheters.

• Practice proper birth preparedness before each delivery to avoid eleventh hour

hassles.




care) in files.




n. CHC Meerpur

• Case records are well maintained, includes delivery notes and baby notes.

Documentation of essential newborn care should be recorded

• Infrastructure available but is under-utilized. 2 labour tables are available.

Delivery load is 8-10 deliveries per month.

• Separate post natal ward available with 2 post natal beds

• Immunization of newborn in practice

• Dose of Vitamin K not clear to staff nurses



• Practice of re-clamping the cord

• Sterilization of bag and mask not in practice


• Rusted delivery instruments

Recommendations




immunization).




care) in files.




o. PHC Bharawas


16 | P a g e

p. PHC Dharuhera


of both sizes, suction machine and oxygen cylinder

• 2 delivery tables are available. Delivery load of 40-45 per month

• Infection prevention protocols needs to be followed


• Vitamin K is not in practice


care is not done

• Partographs are inaccurately filled

• Staff nurses unable to adjust the pressure of automatic suction machine

Recommendations




immunization).




care) in files.




q. PHC Masani






• Vitamin K in practice

• Suctioning of newborn is rampant

• Augmentation of labour with oxytocin in practice

Recommendations




care) in files.




17 | P a g e

r. CHC Nahar

• Vit. K available in facility but not given to new-borns

• Case records need improvements. New-bron notes not written in details. No vitals

for new-born recorded.

• Infection prevention and hygiene protocols not followed.

o AMBU bag and mask are not disinfected regularly.

o Suction apparatus is not disinfected regularly.

• Knowledge of staff nurses is poor for providing following services,

o Identification of high risk pregnancies

o Identification of true labour pains

o Immediate care for new-born

o Identification of infection/sepsis in new-born

o Active management of third stage of labour (only 5 IU oxytocin given

after delivery)

o Special care for low birth weight new-borns

o Neonatal Resuscitation

• Knowledge of staff nurses is average for providing following services,

o ANC

o Monitoring of labour progress

• New-born shifted to radiant warmer immediately after birth.

• Skin to skin contact not maintained.

• 1st breast feeding is delayed. Normally after ½ hrs. after birth.

Recommendations




immunization).




care) in files.




s. PHC Bawwa

• Immunization of newborn with BCG, OPV and Hep B in practice.

• Vitamin K in practice.

• Case records are not properly maintained. History of mother not being recorded.

Documentation of essential newborn care is not done.

• Partographs are inaccurately filled.




18 | P a g e


• Labour room is congested

• Oxygen cylinder non-functional at the time of visit


Recommendations

• Provide baby sheets in sufficient number (at least 2 sheets per delivery).




care) in files.




t. PHC Guriani

• Double gloving in practice

• Immunization of newborn with BCG, OPV and Hep B in practice from current

month

• Vitamin K is not available and not in practice





care is not done

• Fumigation of labour room in practice

• Sterilization of bag and mask not in practice.

Recommendations




immunization).




care) in files.




u. SC Chillar

• Same use and throw mucus extractor was being used repeatedly. Diposable mucus

extractor should be used only once at a time.

19 | P a g e

• The feeding tubes, which were being used for suction had crossed their expiry

date 2 years back. No expiry dated equipment should be used, please replace the

same.

• Rusted delivery instruments should be replaced with new one.

• Cradle was being utilized for every baby after delivery. Cradle should never be

used in either labor room or in postpartum room.

• Simple examination table was being used instead of labor table.

• Less lightening in labor room. Please ensure adequate lightening for labor room.

• Labor room thermometer was broken down, please replace the same.

• Immediate cord cutting in practice. Delayed cord cutting should be practiced with

duration of 1 to 3 minutes.

• All the newborns shifted to newborn corner. Only those babies who require

resuscitation should be shifted to NBCC.

v. SC Jadra




• NBCC establish with 200 W bulb, shoulder roll and suction apparatus

• Labour room congested

• Infection prevention protocols are not being followed

w. SC Kapriwas

• Oxygen cylinder is not available.

• Room thermometer is not available.

• Case files are not available.

• Autoclave is available but not in use.

• Resuscitation skills of ANM is good.

• Partographs are not maintained.

• Disinfection protocols are not followed.

• Vitamin k is not administered to newborns.

x. SC Nangal Shebazpur


assessment district rewari - · pdf filethe findings of district rewari in general are as...

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