introducing and sustaining eenc in hospitals: routine...

E A R L Y E S S E N T I A L N E W B O R N C A R E ( E E N C ) m O d u l E 3

Introducing and sustaining EENC in hospitals: routine childbirth and newborn care

E A R L Y E S S E N T I A L N E W B O R N C A R E ( E E N C ) M O D U L E 3

Introducing and sustaining EENC in hospitals: routine childbirth

and newborn care

WHO Library Cataloguing-in-Publication Data

Introducing and sustaining EENC in hospitals: routine childbirth and newborn care (Early Essential Newborn Care)

1. Infant, Newborn. 2. Infant care – standards. 3. Guideline. 4. Postnatal care.

I. World Health Organization Regional Office for the Western Pacific.

ISBN 978 92 9061 780 8 (NLM Classification: WS 420)

© World Health Organization 2016All rights reserved.

Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press: World Health Organization – 20, avenue Appia – 1211 Geneva 27, Switzerland (tel. +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]).

Requests for permission to reproduce or translate WHO publications – whether for sale or for non-commercial distribution – should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html). For WHO Western Pacific Region publications, requests for permission to reproduce should be addressed to Publications Office, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines, fax: +632 521 1036, e-mail: [email protected].

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate borderlines for which there may not yet be full agreement.

The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.

Cover, photo credit: © WHO/Yoshi Shimizu

CONTENTS

Foreword .................................................................................................................................................................................................................................. v

About the EENC modules .........................................................................................................................................................................................vi

BACKGROUND ......................................................................................................................................................................................................................1

SECTION 1. Review EENC clinical practice ...........................................................................................................................................3

1.1 Exit interviews with postpartum mothers – (Checklist 1) .......................................................................................3

1.2 Chart reviews of postpartum mothers who received an exit interview – (Checklist 2) ........................4

1.3 Observation of delivery practices and environmental hygiene – (Checklists 3a, 3b, 3c) ...................5

1.4 Review of availability of key medicines and supplies for EENC – (Checklist 4) .........................................6

1.5 Review of hospital policies: support of EENC practices – (Checklist 5)..........................................................6

1.6 Review of EENC coaching status of facility staff (Checklist 6).............................................................................7

1.7 Review of hospital impact indicators (Checklists 7a, 7b) ......................................................................................7

SECTION 2. Identify and prioritize EENC strengths and areas for improvement ..............................................8

SECTION 3. Identify priority actions for improving EENC ...................................................................................................10

CHECKLISTS .........................................................................................................................................................................................................................13

CHECKLIST 1. Exit interviews with postpartum mothers..........................................................................................................................14

CHECKLIST 2. Chart reviews of postpartum mothers who received an exit interview ...........................................................16

CHECKLIST 3a. Delivery practice for the breathing baby ............................................................................................................................18

CHECKLIST 3b. Delivery practice for the non-breathing baby ..................................................................................................................20

CHECKLIST 3c. Environmental hygiene ...................................................................................................................................................................22

CHECKLIST 4. Review of availability of key medicines and supplies for EENC ............................................................................24

CHECKLIST 5. Review of hospital policies: support of EENC practices ............................................................................................26

CHECKLIST 6. EENC coaching summary ............................................................................................................................................................28

CHECKLIST 7a. EENC hospital impact indicators ............................................................................................................................................29

CHECKLIST 7b. Progress in EENC hospital impact indicators in the previous 12 months .......................................................30

v

Foreword

WHO, Member States and stakeholders in the Western Pacific Region share a vision for mothers and their children: that every newborn infant have the right to a healthy start in life.

But now one newborn infant dies every two minutes – often needlessly – in the Region.

Together, we have taken bold steps to address this grim statistic, with Member States endors-ing the Action Plan for Healthy Newborn Infants in the Western Pacific Region (2014–2020). The plan aims to improve the quality of care for mothers and babies in health facilities, where the vast majority of children are born in the Region.

We offer five teaching modules of Early Essential Newborn Care, or EENC, starting with the Early Essential Newborn Care Clinical Practice Pocket Guide. Since its release, reviews and research have shown impressive reductions in death, infection and intensive care unit admis-sions in facilities employing EENC.

The current volume, Introducing and sustaining EENC in hospitals: routine childbirth and newborn care, is the third module for improving EENC health provider practices in facilities across the Region.

These modules are critical components of the regional plan of sustained action and strong policies utilizing proven methods for saving money and lives. Already governments, health-care facilities and families are saving precious resources, making health systems more accountable and quality care more attainable.

Together, we must push beyond the era of the Millennium Development Goals and meet the even loftier targets for the Sustainable Development Goals: a global maternal mortality ratio of less than 70 per 100 000 live births with no country above 140; and a neonatal mortality rate of less than 12 per 1000 births in countries.

To reach these ambitious targets, we must work together with Member States and partners to bring improved high-quality EENC to all mothers and newborn infants in every stretch of the Region.

Shin Young-soo, MD, Ph.D.Regional Director

ABOUT THE EARLY ESSENTIAL NEWBORN CARE MODULES

The fi ve Early Essential Newborn Care (EENC) modules support planning, imple-mentation, improvement, and monitoring and evaluation of EENC.

Module Title Primary user level

1 Annual implementation reviews and planning National and subnational

2 Coaching for the First Embrace – Facilitator's GuideNational and subnational facilitators

p 3Introducing and sustaining EENC in hospitals:

routine childbirth and newborn care

Hospital with national support for scale up

4Introducing and sustaining EENC in hospitals:

Kangaroo Mother Care (KMC) for preterm infants

5Introducing and sustaining EENC in hospitals:

managing childbirth and postpartum complications

Module 1 is used at the national and subnational levels to collect data for development of annual and 5-year national strategic plans.

National and subnational facilitators use Module 2 to upgrade skills of health workers provid-ing routine childbirth and newborn care nationwide. In hospitals, EENC teams are formed to regularly assess and improve quality of care using Module 3. Once excellent routine childbirth and newborn care are well established, coaching and quality of improvement for Kangaroo Mother Care (KMC) for preterm infants is done with Module 4. Lastly, management of childbirth and postpartum complications is added using Module 5 (see below).

FACILITATORS GUIDE

Coaching guide for the First Embrace


M O D U L E 2

Routine childbirth and newborn careINTRODUCING AND SUSTAINING EENC IN HOSPITALS


M O D U L E 3

Kangaroo mother care (KMC) for preterm infantsINTRODUCING AND SUSTAINING EENC IN HOSPITALS


M O D U L E 4

Managing childbirth and postpartum complicationsINTRODUCING AND SUSTAINING EENC IN HOSPITALS


M O D U L E 5

2-day coaching KMC for pre-term infants

Managing complications

Formation of EENCteam

Quarterly EENC assessments through weekly / bi-weekly progress monitoring meetings to improve clinical practice

vi

p

1

This module aims to provide the EENC hospital team with a practical approach to assess and improve the quality of routine childbirth and newborn care. The team will use data from observations, interviews and reviews of charts, policies and hospital registers to complete checklists, identify priorities and develop plans.

PARTICIPANTS

EENC team members include paediatricians, obstetricians, nurses, midwives and infection control, quality improvement and hospital administration staff (maximum of 25). These should include senior staff in key positions as well as mid-level staff to carry out the work. Participants are divided into small groups and collect data using checklists.

TIMING

Six to 13 weeks after the 2-day First Embrace coaching, an initial full EENC quality as-sessment is conducted. Thereafter, regular team meetings are held at least monthly. A day-long EENC quality assessment (Module 3, 4 or 5) is conducted at least twice a year. The EENC team may decide to conduct assessments more frequently, depending on the status and quality of EENC practice.

MATERIALS NEEDED FOR INITIAL FULL EENC QUALITY ASSESSMENT

Module 3 (one per participant); flipchart (1–2) with A1-size paper (10); markers (10), tape.

BACKGROUND

2

EENC Module 3 – Introducing and sustaining EENC in hospitals: routine childbirth and newborn care

TABLE 1. Content of the full EENC quality assessment

Quality improvement action

Tasks Tools Method followed in orientation

SECTION 1: Review EENC clinical practice

• Interview postpartum mothers Checklist 1

Data collection in pairs/groups, then summarize in plenary

• Review charts of postpartum mothers Checklist 2

• Observe delivery practice and environmental hygiene

Checklists 3a, 3b, 3c

• Review availability of key medicines and supplies for EENC Checklist 4

• Review hospital policies: support of EENC practices Checklist 5

• Review EENC coaching status of facility staff Checklist 6

• Review hospital impact indicators Checklists 7a, 7b

SECTION 2: Identify and prioritize EENC strengths and areas for improvement

• Identify and prioritize EENC strengths

Table 2Group work per topic, then plenary discussion

• Identify and prioritize EENC areas for improvement

SECTION 3: Identify priority actions for improving EENC

• Develop action steps

Table 3Group work per topic, then plenary discussion

• Assign responsibility

• Review progress regularly

3

Exit interviews with postpartum mothers Checklist 10

Instructions

1. Divide the EENC team into pairs, with each pair conducting at least two exit interviews – one person interviewing and the other recording. Altogether, a minimum of 10 interviews should be conducted. Interviews should be completed before women are discharged.

2. Select a room away from patients and staff for conducting interviews. If this is not possible, locate a quiet corridor or area where the conversation can be more private.

3. Select mothers using these criteria:

– Delivered at least three hours prior to the interview.

– A mix of women with normal vaginal deliveries, assisted deliveries, and caesarean sections (when present) and babies in the neonatal care unit (NCU).

– Have not been admitted for abortion, or had a stillbirth or newborn death.

– If 10 or fewer postpartum mothers meeting the criteria are available, select all mothers.

– If more than 10 postpartum mothers meeting the selection criteria are available, use a random sampling method.1

4. Obtain informed oral consent. State, “We are trying to understand your delivery experi-ence so that we can help improve care for women. Everything you say here will be kept confidential, meaning no one will know you said it. Anytime you want to stop, you may. Your care will remain the same. Do you agree to do this interview?” Record informed consent if given.

1. If more than 20 women meet the selection criteria, consider systematic random sampling. Number the women in the delivery admission register in the order they arrived. Divide the total number of admissions in the register by 10 to �nd the sampling interval (for example, if 40 women meet the criteria, select every fourth women on the list). Start randomly and use the sampling interval to select women from the random start until 10 women have been sampled.

1.1

SECTION 1.

REVIEW EENC CLINICAL PRACTICE

4


5. Conduct the exit interview and record in a notebook.

– State: “We would like to start by asking you to describe what happened to you from the moment you went into labour until now.”

– Probe: the silent probe (i.e. maintaining silence even after you feel uncomfortable) with head nods is very effective in allowing women to tell their story. This can be followed by: “so the first thing that happened was… [repeat what was said], what happened next?” Keep probing to fill in the details.

– Write down the “story” of her labour and delivery. Ask her to tell it in her own words. Record the story in a notebook, making special note of responses to questions in Checklist 1 – Exit interviews with postpartum mothers. If by the end, the mother does not tell you specific details spontaneously, then use the questions in Checklist 1. For #12 in Checklist 1, you will need to ask the mother the question as she is unlikely to mention this in her narration. If the mother answers “yes”, ask her to show you the items she has bought herself or received from baby food companies.

– The questions in Checklist 1 should not be used to conduct the interview until the mother has finished telling the story.

6. Extract information from notebook and record in Checklist 1 indicating Y (Yes), N (No), or as otherwise instructed in the questions.

7. In plenary, tally findings from all exit interviews in the summary column of Checklist 1.

Chart reviews of postpartum mothers who received an exit interview Checklist 20

Instructions

1. In pairs, use the identification numbers of the mother and baby to identify the charts of women who already received an exit interview. If mothers’ charts are separate from those of their babies, it may be necessary to review both to complete the chart review.

2. In pairs, complete Checklist 2 – Chart reviews of postpartum mothers who received an exit interview. If data are not recorded in the chart, the response is “NR” (Not Recorded).

3. In plenary, tally the results in the summary column of Checklist 2.

1.2

5

Observation of delivery practices and environmental hygiene

Instructions

Observation of delivery practices Checklists 3a and 3b0

1. Ask delivery and operation room staff to notify the group of pending deliveries and cae-sarean sections. At least five deliveries should be observed. As cases requiring resuscitation are uncommon, participants may not have the opportunity to observe such a delivery.

2. In pairs, move about to get a clear view without obstructing the birth attendant(s), speak-ing or intervening.

3. Observe the same delivery, record findings individually on Checklist 3a – Delivery practice for the breathing baby or Checklist 3b – Delivery practice for the non-breathing baby as: correctly done (Y = Yes), incompletely done (P = Partial) or not done or done incorrectly (N = No). If a practice is not assessed, indicate N/A and provide details in the “Comments” column.

4. After each observation, score the checklist: 2 points for “Yes”, 1 point for “Partial” and 0 points for “No.” The maximum possible score for delivery of a breathing baby (Checklist 3a) is 42 and non-breathing baby (Checklist 3b) is 60. Upon completion, compare findings in the pair and reconcile differences. Record average scores and score ranges in completed checklists.

5. Give feedback to staff at the end of the delivery away from the mother. Provide positive feedback first, then describe areas for improvement.

Observation of environmental hygiene Checklist 3c0

1. Observe handwashing facilities and toilets for patients, newborn resuscitation areas and supply and equipment in delivery rooms, postnatal care rooms (PNC) and neonatal care units.

2. Complete Checklist 3c – Environmental hygiene.

3. For each aspect of environmental hygiene assessed, record the total number of observa-tions (N) and of these, how many meet the criteria asked (n)?

4. Give feedback to staff at the end of the review on areas for improvement.

1.3

6


Review of availability of key medicines and supplies for EENC Checklist 40

Instructions

1. Review the list of medicines and supplies by direct observation – staff who work in ante-natal care (ANC), delivery, postnatal care and neonatal care areas are often familiar with the availability of essential medicines, equipment and supplies and can help identify where medicines and supplies are stored and answer key questions.

2. If EENC team members are unsure of the status of some medicines or supplies, determine who should be consulted to determine the status. This may include staff from the relevant section or the hospital pharmacy.

3. Complete Checklist 4 – Review of availability of key medicines and supplies for EENC.

– The WHO definition of normal storage conditions is: “Storage in dry, well-ventilated premises at temperatures of 15–25 °C or, depending on climatic conditions, up to 30 °C”.

– Note items not available on the day of the review and those that have had stock-outs in the previous 12 months. Note problems with storage or functionality of equipment.

– Note whether stock records are available for all items.

Review of hospital policies: support of EENC practices Checklist 50

Instructions

1. Get copies of hospital policies listed in Checklist 5 – Review of hospital policies: support of EENC practices.

Note: national policies are not included unless a written policy is available at the hospital.

2. Record policies seen in Checklist 5 and identify policies currently not available.

3. Determine whether all relevant staff have been oriented on the available written policies.

1.4

1.5

7

Review of EENC coaching status of facility staff Checklist 60

Instructions

1. List the types of health professionals at the hospital involved in childbirth, postnatal and newborn cares in Checklist 6 – EENC coaching summary.

2. Identify the total number of staff for each type of health professional.

3. Identify the total number of staff coached and the number who still need to be coached. Ensure new and trainee staff are included and that staff who have departed are not counted. If any staff members have been coached more than once, count them only once.

4. Decide on a responsible person and time line for completing coaching.

5. Identify resources needed to complete coaching such as manikins, essential supplies or other materials. Discuss sources of support.

Review of hospital impact indicators Checklist 70

Instructions

1. Review data collected for the last 12 months for each hospital impact indicator – indicators are summarized in Checklist 7a – EENC hospital impact indicators.

– Discuss the type of database most suitable for the facility (Excel database, other elec-tronic database). If necessary, discuss adaptation of the database format to facilitate data entry and reporting.

– Discuss problems with collecting data for hospital impact indicators, such as record completeness or case-definitions and possible solutions.

– Discuss and note trends in indicators over the past 12 months (changes in mortality or case-fatality rates, changes in asphyxia, sepsis, prematurity or low-birth weight, and NCU admission rates), and possible reasons for observed trends in Checklist 7b – Progress in EENC hospital impact indicators in the previous 12 months.

– Note data inconsistencies and gaps in the database, and possible reasons and solu-tions for them.

1.6

1.7

8


Instructions

1. Draw Checklists 1, 2, 3a, 3b, 3c, 4, 5, 6 and 7 on flipcharts and enter the data collected.

2. Draw Table 2 – Identifying and prioritizing strengths and areas for improvement for EENC on another flipchart.

3. Post completed flipcharts of each checklist around the room in order (Checklists 1, 2, 3a, 3b, 3c, 4, 5, 6 and 7).

4. Starting on Checklist 1, identify strengths and gaps including those that have not been re-corded in checklists. Mark the two or three most important gaps, giving consideration to:

– importance to improving EENC clinical practice;

– whether action to address the gap can be taken with existing resources and personnel; and

– whether action to address the gap can be taken in the next three months.

5. Reach consensus on the most important strengths, gaps and underlying reasons. Write them word-for-word on Table 2.

SECTION 2.

IDENTIFY AND PRIORITIZE EENC STRENGTHS AND AREAS FOR IMPROVEMENT

9

TABLE 2. Identifying and prioritizing strengths and areas for improvement for EENC

Areas StrengthsPriority areas

for improvement Underlying reasons

Clinical practice a

Environmental hygiene

Key medicines and supplies

Hospital policies

EENC coaching for staff

Hospital impact indicators

a. Based on data collected from exit interviews, chart reviews, and observations of deliveries.

10


Purpose

Actions required to address areas needing improvement are developed, based on the underly-ing reasons for gaps identified in the previous step. Responsibilities are allocated to members of the EENC team. Some solutions will be relatively easy to implement with available staff and resources. Others may require the intervention of senior hospital managers or additional resources. Some solutions may require actions outside of the hospital – for example advocacy to improve supply of essential medicines or commodities.

Instructions

1. Draw Table 3 – Priority actions for improving EENC on a flipchart and post next to Table 2. Referring to Table 2, discuss priority actions to address underlying issues, person(s) respon-sible and timing. Leave status blank (it will be updated during subsequent team meetings).

2. Discuss and agree on up to three actions per priority area for improvement. Answer the following questions:

– If we complete our actions, will we improve EENC?

– Can we measure if the action has been completed?

– Can we feasibly complete it within three months? (Or for longer-term priorities, can we substantially start the process within three months?)

3. Write the agreed actions on the flipchart.

4. Agree on the date and time of the next EENC hospital team meeting.

5. Discuss mechanisms to ensure that quarterly EENC assessments are carried out.

SECTION 3.

IDENTIFY PRIORITY ACTIONS FOR IMPROVING EENC

11

TABLE 3. Priority actions for improving EENC

Priority actions Person responsible Time Status date

Clinical practice

Environmental hygiene

Key medicines and supplies

Hospital policies

EENC coaching for staff

Hospital impact data

13

EENC Module 3 Introducing and sustaining EENC in hospitals: routine childbirth and newborn care

Checklists

CHECKLIST 1. Exit interviews with postpartum mothers..........................................................................................................................14

CHECKLIST 2. Chart reviews of postpartum mothers who received an exit interview ...........................................................16

CHECKLIST 3a. Delivery practice for the breathing baby ............................................................................................................................18

CHECKLIST 3b. Delivery practice for the non-breathing baby ..................................................................................................................20

CHECKLIST 3c. Environmental hygiene ...................................................................................................................................................................22

CHECKLIST 4. Review of availability of key medicines and supplies for EENC ............................................................................24

CHECKLIST 5. Review of hospital policies: support of EENC practices ............................................................................................26

CHECKLIST 6. EENC coaching summary ............................................................................................................................................................28

CHECKLIST 7a. EENC hospital impact indicators ............................................................................................................................................29

CHECKLIST 7b. Progress in EENC hospital impact indicators in the previous 12 months .......................................................30

A printable Excel file for data entry and automatic calculation of summary information is available at:http://www.wpro.who.int/reproductive_maternal_newborn_child_adolescent/publications/20160901-mca-template.xlsx.

14


Chec

klist

1. E

xit i

nter

view

s w

ith p

ostp

artu

m m

othe

rs

Que

stio

n M

othe

r nu

mbe

rSu

mm

ary

Ans

wer

the

que

stio

ns w

ith:

Y (=

Yes

) or N

(= N

o)1

23

45

67

89

10n*

/ N

** (%

)

1.

Verb

al in

form

ed c

onse

nt o

btai

ned

2.

Iden

tifyi

ng in

form

atio

n of

mot

her a

nd b

aby

(p

rovi

de h

ere)

3.

Mod

e of

del

iver

y (V

= v

agin

al, C

S =

caes

area

n se

ctio

n)n

CS =

4.

Age

of th

e ba

by (i

n ho

urs)

5.Du

ring

child

birth

:a.

was

the

mot

her a

llow

ed to

sit,

stan

d or

lay

in

the

posit

ion

she

wan

ted?

b.

if y

es, in

wha

t pos

ition

did

she

spen

d m

ost o

f the

tim

e?

c. di

d th

e m

othe

r hav

e a

com

pani

on o

f her

cho

ice?

d. w

as th

e m

othe

r enc

oura

ged

to e

at a

nd d

rink?

e. di

d an

yone

pus

h do

wn

on th

e m

othe

r’s b

elly?

f. w

as a

n en

ema

done

?

6.W

as th

e ba

by b

athe

d?a.

if

yes,

how

long

afte

r birt

h?

<1

h, 1

–6 h

, 7–2

4 h,

≥ 24

hn

≥ 24

h =

7.W

as th

e ba

by p

lace

d in

ski

n-to

-ski

n co

ntac

t with

th

e m

othe

r?

a. h

ow lo

ng a

fter b

irth

(<1,

1–1

0, 1

1–59

, ≥ 60

min

)?n

< 1

min

=

b. h

ow lo

ng d

id th

e ba

by re

mai

n in

uni

nter

rupt

ed

skin

-to-s

kin

cont

act b

efor

e be

ing

sepa

rate

d fro

m

the

mot

her f

or a

ny re

ason

?

(<10

, 10–

29, 3

0–59

, 60–

89, ≥

90 m

in)

n ≥ 9

0 m

in =

c. ha

d th

e ba

by c

ompl

eted

the

first

bre

astfe

ed

(atta

ched

, dee

p su

ckin

g) b

efor

e be

ing

sepa

rate

d

from

the

mot

her?

CHECKLIST 1

Exit interviews with postpartum mothers

15

Que

stio

n M

othe

r nu

mbe

rSu

mm

ary

Ans

wer

the

que

stio

ns w

ith:

Y (=

Yes

) or N

(= N

o)1

23

45

67

89

10n*

/ N

** (%

)

d. w

hy w

as th

e ba

by se

para

ted

from

the

mot

her?

Reas

ons:

e. di

d th

e ba

by re

ceive

imm

edia

te sk

in-to

-ski

n co

ntac

t, no

sepa

ratio

n fo

r at l

east

90

min

and

unt

il th

e fir

st

brea

stfe

ed w

as c

ompl

eted

?

Answ

er Y

onl

y if:

a <

1 m

in, b

≥ 9

0 m

in a

nd c

= Y

8.

Did

the

baby

sta

y w

ith th

e m

othe

r dur

ing

the

entir

e ho

spita

l sta

y (ro

omin

g in

)?

9.Is

the

mot

her b

reas

tfeed

ing?

a. i

f yes

, how

long

afte

r birt

h di

d th

e ba

by fi

rst

brea

stfe

ed?

(<15

, 15–

90, >

90

min

) (at

tach

ed,

deep

suck

ing)

15 <

n <

90

min

=

b. h

ow lo

ng d

id th

e ba

by b

reas

tfeed

the

first

tim

e?n ≥

15 m

in =

c. sin

ce d

elive

ry, w

as th

e ba

by fe

d an

ythi

ng o

ther

th

an b

reas

tmilk

?

n (#

No)

=

d. d

id th

e ba

by re

ceive

ear

ly (w

ithin

15–

90 m

in)

and

exclu

sive

brea

stfe

edin

g?

An

swer

Y o

nly

if: 1

5 <

a <

90

min

and

c =

N10

.If

the

baby

has

bee

n fe

d an

ythi

ng o

ther

th

an b

reas

tmilk

, wha

t was

giv

en?

Flui

ds g

iven

:

11.

Has

the

baby

bee

n fe

d an

ythi

ng fr

om a

bot

tle?

12.

Was

any

thin

g ap

plie

d to

the

cord

stu

mp?

a. i

f yes

, wha

t was

app

lied?

Su

bsta

nces

:

13.

Does

the

mot

her h

ave

infa

nt fo

rmul

a, b

aby

bottl

es,

gifts

or o

ther

pro

duct

s sp

onso

red

by b

aby

food

co

mpa

nies

with

her

at t

he h

ospi

tal?

a. i

f yes

, ask

her

to sh

ow th

em to

you

and

not

e do

wn

the

type

s of p

rodu

cts.

Prod

ucts

:

CHECKLIST 1

Exit interviews with postpartum mothers (continued)

* n =

tota

l num

ber o

f “Y”

(Yes

) res

pons

es u

nles

s oth

erw

ise

spec

i�ed

**N

= to

tal n

umbe

r of m

othe

rs in

terv

iew

ed

16


Chec

klist

2. C

hart

revi

ews

of p

ostp

artu

m m

othe

rs w

ho re

ceiv

ed a

n ex

it in

terv

iew

Que

stio

n M

othe

r nu

mbe

rSu

mm

ary

Ans

wer

the

que

stio

ns w

ith:

1

23

45

67

89

10n*

/ N

** (%

) Y

(= Y

es),

N (=

No)

, NR

(= N

ot R

ecor

ded)

1.

Iden

tifyi

ng in

form

atio

n of

mot

her a

nd b

aby

(pro

vide

her

e)

2.

Wer

e sy

phili

s te

st re

sults

from

AN

C w

ritte

n in

the

reco

rd?

3.

Was

poi

nt-o

f-car

e ra

pid

HIV

test

ing

done

or H

IV te

st re

sults

fro

m A

NC

writ

ten

in th

e re

cord

?

4.W

as a

par

togr

aph

com

plet

ed c

orre

ctly

? a

a. i

f par

tial o

r no,

spec

ify re

ason

Mai

n re

ason

s:

5.W

as a

rtific

ial r

uptu

re o

f mem

bran

es (a

mni

otom

y) d

one?

a. i

f yes

, wha

t wer

e th

e in

dica

tions

?M

ain

indi

catio

ns:

6.W

as th

e m

othe

r’s la

bour

indu

ced

or a

ugm

ente

d

with

oxy

toci

n?

a. i

f yes

, wha

t wer

e th

e in

dica

tions

?M

ain

indi

catio

ns:

7.W

as th

e ba

by d

eliv

ered

by

caes

area

n se

ctio

n?

a. i

f yes

, wha

t wer

e th

e in

dica

tions

?M

ain

indi

catio

ns:

8.

Was

an

episi

otom

y do

ne?

a. i

f yes

, wer

e re

stric

ted

crite

ria fo

r epi

sioto

my

used

? b

9.W

as IM

oxy

toci

n gi

ven

afte

r del

iver

y?

10.

Wer

e an

y su

bsta

nces

put

on

the

cord

stu

mp,

e.

g. a

lcoh

ol, t

riple

dye

, gen

tian

viol

et?

a. i

f yes

, wha

t was

app

lied?

Mai

n su

bsta

nces

:

CHECKLIST 2

Chart reviews of postpartum mothers who received an exit interview

17

Que

stio

n M

othe

r nu

mbe

rSu

mm

ary

Ans

wer

the

que

stio

ns w

ith:

1

23

45

67

89

10n*

/ N

** (%

) Y

(= Y

es),

N (=

No)

, NR

(= N

ot R

ecor

ded)

11.

Wer

e th

e fo

llow

ing

asse

ssed

with

in 1

hou

r of d

eliv

ery?

a. v

agin

al b

leed

ing

b. f

unda

l hei

ght a

nd u

terin

e co

ntra

ctio

n

c. p

ulse

and

blo

od p

ress

ure

of th

e m

othe

r

d. t

empe

ratu

re o

f the

mot

her

e. d

ange

r sig

ns o

f the

bab

y

12.

Was

rout

ine

eye

care

giv

en w

ithin

90

min

of b

irth?

c

13.

Was

vita

min

K g

iven

bet

wee

n 90

min

and

6 h

of b

irth?

c

14.

Was

hep

atiti

s B

vacc

ine

give

n w

ithin

24

h of

birt

h? c

15.

Was

BCG

vac

cine

giv

en w

ithin

24

hour

s of

birt

h? c

16.

Whi

ch o

f the

follo

win

g w

ere

asse

ssed

with

in 6

hou

rs

of d

eliv

ery?

a. s

econ

d bl

ood

pres

sure

of m

othe

r

b. u

rine

void

c. f

ull p

hysic

al e

xam

of b

aby

a.

P =

par

tial m

ay b

e ap

plic

able

. If t

he a

sses

sor i

s un

able

to d

eter

min

e w

heth

er th

e pa

rtog

raph

has

bee

n fil

led

corr

ectly

, the

ans

wer

sho

uld

be v

alid

ated

w

ith th

e ov

erse

eing

sta

ff m

embe

r/at

tend

ing

phys

icia

n.b.

A

bnor

mal

pro

gres

sion

of la

bour

; non

-rea

ssur

ing

feta

l hea

rt ra

te p

atte

rn; v

acuu

m o

r for

ceps

del

iver

y; s

houl

der d

ysto

cia.

c.

If tim

ing

of a

dmin

istr

atio

n is

not s

peci

fied,

indi

cate

“Y”

and

“TN

S” (t

ime

not s

peci

fied)

.

Chec

klist

2. C

hart

revi

ews

of p

ostp

artu

m m

othe

rs w

ho re

ceiv

ed a

n ex

it in

terv

iew

(con

tinue

d) CHECKLIST 2

Chart reviews of postpartum mothers who received an exit interview (continued)

* n =

tota

l num

ber o

f “Y”

(Yes

) res

pons

es u

nles

s oth

erw

ise sp

eci�

ed**

N =

tota

l num

ber o

f cha

rts r

evie

wed

18


Chec

klist

3a.

Del

iver

y pr

actic

e fo

r the

bre

athi

ng b

aby

Loca

tion:

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.. D

ate:

......

......

......

......

......

......

......

......

......

......

......

......

Obs

erva

tion

cond

ucte

d by

: ......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

....

Ans

wer

the

que

stio

ns w

ith:

Obs

erva

tion

Sum

mar

yY

= Y

es, N

= N

o, P

= P

artia

l, N

/A =

Not

Ass

esse

d 1

23

45

n* /

N**

(%)

Vagi

nal =

V, C

aesa

rean

sec

tion

= C

S

Pre-

birt

h pr

epar

atio

n

1.

Chec

ked

room

tem

pera

ture

; tur

ned

off f

ans a

nd/o

r air

cond

ition

ing

2.

Was

hed

hand

s be

fore

touc

hing

any

del

iver

y ar

ea s

urfa

ces

and

hand

ling

equi

pmen

t

3.

Plac

ed d

ry c

loth

on

abdo

men

(or u

pper

bod

y fo

r cae

sare

an s

ectio

n)

4.

Prep

ared

the

new

born

resu

scita

tion

area

5.

Chec

ked

if ne

wbo

rn a

mbu

bag

and

mas

ks a

re fu

nctio

nal

6.

Was

hed

hand

s be

fore

glo

ving

for d

eliv

ery

7.

Wor

e tw

o pa

irs o

f ste

rile

glov

es (i

f nec

essa

ry) a

8.

Arra

nged

forc

eps,

cord

cla

mp/

ties

in e

asy-

to-u

se o

rder

Imm

edia

te p

ostp

artu

m / n

ewbo

rn a

ctiv

ities

9.

Calle

d ou

t tim

e of

birt

h (h

ours

, min

utes

, sec

onds

) ...

......

. / ...

......

. / ...

......

.

10.

Dryi

ng s

tarte

d w

ithin

5 s

of b

irth?

*An

swer

: <5

s (Y)

, 5 –

10 s

(P),

>10

s (N

)

11.

Drie

d th

e ba

by th

orou

ghly

(wip

ed th

e ey

es, m

outh

, nos

e,fa

ce, h

ead,

fron

t, ba

ck,

arm

s an

d le

gs) b

CHECKLIST 3a

Delivery practice for the breathing baby

19

Ans

wer

the

que

stio

ns w

ith:

Obs

erva

tion

Sum

mar

yY

= Y

es, N

= N

o, P

= P

artia

l, N

/A =

Not

Ass

esse

d 1

23

45

n* /

N**

(%)

Vagi

nal =

V, C

aesa

rean

sec

tion

= C

S

Imm

edia

te p

ostp

artu

m / n

ewbo

rn a

ctiv

ities

(con

tinue

d)

12.

Rem

oved

the

wet

clo

th

13.

Plac

ed b

aby

in d

irect

ski

n-to

-ski

n co

ntac

t

14.

Cove

red

baby

’s bo

dy w

ith c

loth

and

hea

d w

ith a

hat

15.

Chec

ked

for a

sec

ond

baby

c

16.

Inje

cted

oxy

toci

n IM

to m

othe

r with

in 1

min

ute

17.

Rem

oved

firs

t (so

iled)

pai

r of g

love

sa

18.

Chec

ked

for c

ord

pulsa

tions

bef

ore

clam

ping

, cla

mpe

d af

ter c

ord

pulsa

tions

st

oppe

d (u

sual

ly 1

–3 m

inut

es)

19.

Plac

ed c

lam

p/tie

at 2

cm

, for

ceps

at 5

cm

, fro

m u

mbi

lical

bas

e

20.

Deliv

ered

pla

cent

a

21.

Coun

selle

d m

othe

r on

feed

ing

cues

(dro

olin

g, m

outh

ope

ning

, ton

guin

g/lic

king

, ro

otin

g, b

iting

han

d, c

raw

ling,

etc

.) –

*Ans

wer

: > 2

cue

s (Y)

, 1–2

cue

s (P)

Tota

l sco

re =

(# Y

es x

2) +

(# P

arti

al)

(m

axim

um s

core

pos

sible

= 4

2)

Aver

age

scor

e =

Scor

e ra

nge

(from

low

est t

o hi

ghes

t) =

a.

If de

liver

y is

by c

aesa

rean

sec

tion

or a

sep

arat

e bi

rth

atte

ndan

t is

avai

labl

e to

han

dle

the

cord

, mak

e a

note

in “

Sum

mar

y”. I

f a s

epar

ate

birt

h at

tend

ant i

s av

aila

ble

to h

andl

e th

e co

rd a

nd u

ses

ster

ile g

love

s w

hen

doin

g so

, sco

re p

ract

ice

as “

Y” (Y

es).

b.

Dedu

ct 5

poi

nts

if su

ctio

ned

unle

ss b

aby

was

drie

d th

orou

ghly

and

bab

y ha

d no

tone

and

am

niot

ic fl

uid

was

mec

oniu

m s

tain

ed.

c.

For c

aesa

rean

sec

tions

, sco

re th

is as

“Y”

(Yes

).

* n =

tota

l num

ber o

f “Y”

(Yes

) res

pons

es u

nles

s oth

erw

ise sp

eci�

ed**

N =

tota

l num

ber o

f obs

erva

tions

Chec

klist

3a.

Del

iver

y pr

actic

e fo

r the

bre

athi

ng b

aby

(con

tinue

d) CHECKLIST 3a

Delivery practice for the breathing baby (continued)

20


CHECKLIST 3b

Delivery practice for the non-breathing babyCh

eckl

ist 3

b. D

eliv

ery

prac

tice

for t

he n

on-b

reat

hing

bab

yLo

catio

n:...

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.....

Dat

e: ...

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

...

Obs

erva

tion

cond

ucte

d by

: ......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

....

Act

ivit

yO

bser

vati

onSu

mm

ary

Y =

Yes

, N =

No,

P =

Par

tial,

N/A

= N

ot A

sses

sed

12

n* /

N**

(%)

Vagi

nal =

V, C

aeas

area

n se

ctio

n =

CS

Pre-

birth

pre

para

tion

1.

Chec

ked

room

tem

pera

ture

; tur

ned

off f

ans a

nd/o

r air

cond

ition

ing

2.

Was

hed

hand

s be

fore

touc

hing

any

del

iver

y ar

ea o

r equ

ipm

ent

3.

Plac

ed d

ry c

loth

on

abdo

men

(or u

pper

bod

y fo

r cae

sare

an s

ectio

n)

4.

Prep

ared

the

new

born

resu

scita

tion

area

5.

Chec

ked

if ne

wbo

rn a

mbu

bag

and

mas

k ar

e fu

nctio

nal

6.

Was

hed

hand

s be

fore

glo

ving

for d

eliv

ery

7.

Wor

e 2

pairs

of s

teril

e gl

oves

(if n

eces

sary

) a

8.

Arra

nged

forc

eps,

cord

cla

mp/

ties

in e

asy-

to-u

se o

rder

Imm

edia

te p

ostp

artu

m / n

ewbo

rn a

ctiv

ities

9.

Calle

d ou

t tim

e of

birt

h (h

ours

, min

utes

, sec

onds

) ....

...... /

......

.... /

......

...

10.

Dryi

ng s

tarte

d w

ithin

5 s

of b

irth?

*An

swer

: < 5

s (Y

), 5–

10 s

(P),

>10

s (N

)

11.

Drie

d th

e ba

by th

orou

ghly

(wip

ed th

e ey

es, m

outh

/nos

e, fa

ce, h

ead,

fron

t, ba

ck, a

rms

and

legs

)

12.

Rem

oved

the

wet

clo

th

13.

Put b

aby

in d

irect

ski

n-to

-ski

n co

ntac

t

14.

Cove

red

baby

’s bo

dy w

ith c

loth

and

hea

d w

ith a

hat

15.

Det

erm

ined

whe

ther

the

baby

was

gas

ping

or n

ot b

reat

hing

16.

Calle

d fo

r hel

p an

d in

form

ed th

e m

othe

r

21

CHECKLIST 3b

Delivery practice for the non-breathing baby (continued)A

ctiv

ity

Obs

erva

tion

Sum

mar

yY

= Y

es, N

= N

o, P

= P

artia

l, N

/A =

Not

Ass

esse

d1

2n*

/ N

** (%

)Va

gina

l = V,

Cae

asar

ean

sect

ion

= C

S

17.

Rem

oved

firs

t (so

iled)

pai

r of g

love

s a

18.

Qui

ckly

cla

mpe

d an

d cu

t cor

d

19.

Mov

ed b

aby

to re

susc

itatio

n ar

ea

20.

Cove

red

baby

qui

ckly

dur

ing

and

afte

r tra

nsfe

r

21.

Posit

ione

d he

ad c

orre

ctly

to o

pen

airw

ays

22.

Appl

ied

face

mas

k fir

mly

ove

r chi

n, m

outh

and

nos

e

23.

Gai

ned

ches

t rise

with

in 1

min

ute

of b

irth b :

......

.... m

in .

......

... s

24.

Sque

ezed

bag

to g

ive

30–5

0 br

eath

s pe

r min

ute

25.

Mai

ntai

ned

good

che

st ri

se th

roug

hout

or t

ook

step

s to

impr

ove

vent

ilatio

n

26.

Afte

r bab

y br

eath

ing

wel

l, st

oppe

d ve

ntila

tion

27.

Retu

rned

to s

kin-

to-s

kin

cont

act,

cove

red

baby

28.

Chec

ked

for a

sec

ond

baby

c

29.

Gav

e ox

ytoc

in IM

to th

e m

othe

r

30.

Deliv

ered

pla

cent

a

31.

Coun

selle

d m

othe

r on

babi

es s

tatu

s fo

llow

ing

resu

scita

tion

and

on fe

edin

g cu

es

*Ans

wer

> 2

cue

s (Y)

, 1–2

cue

s (P)

Tota

l sco

re =

(# Y

es x

2) +

(# P

arti

al)

(m

axim

um s

core

= 6

2) d

Aver

age

scor

e =

Scor

e ra

nge

(from

low

est t

o hi

ghes

t) =

a.

If de

liver

y is

by c

aesa

rean

sec

tion,

or a

sep

arat

e bi

rth

atte

ndan

t is

avai

labl

e to

han

dle

the

cord

, mak

e a

note

in “

Sum

mar

y”. I

f a s

epar

ate

birt

h at

tend

ant i

s av

aila

ble

to h

andl

e th

e co

rd a

nd u

ses

ster

ile g

love

s w

hen

doin

g so

, sco

re p

ract

ice

as “

Y” (Y

es).

b.

O

nly

scor

ed a

s “Y

es”

or “

No”

– N

o: “

Part

ial”

c.

Fo

r cae

sare

an s

ectio

ns, s

core

this

as “

Y” (Y

es).

d.

Dedu

ct 5

poi

nts

if re

susc

itatio

n is

perf

orm

ed w

hen:

(1) t

he b

aby

is no

t br

eath

ing

but

has

mus

cle

tone

and

grim

ace,

and

(2) t

he b

aby

is no

t dr

ied

imm

edia

tely

or

thor

ough

ly (e

ither

not

imm

edia

tely,

not

thor

ough

ly o

r not

at a

ll).

* n =

tota

l num

ber o

f “Y”

(Yes

) res

pons

es u

nles

s oth

erw

ise sp

eci�

ed**

N =

tota

l num

ber o

f obs

erva

tions

22


Chec

klist

3c.

EN

VIRO

NM

ENTA

L HY

GIE

NE

Deliv

ery

room

, rec

over

y ro

om, n

eona

tal c

are

unit

and

post

nata

l car

e ro

om

Que

stio

nDe

liver

y ro

om(s

)Re

cove

ry

room

(s)

Neo

nata

l ca

re u

nit

PNC

room

(s)

Com

men

ts

Han

dwas

hing

faci

litie

s an

d to

ilets

for p

atie

nts a

1.

Is th

ere

a fil

led

alco

hol h

and

gel d

ispen

ser w

ithin

2 m

of e

very

bed

? (Y

/ N

)

2.

Is a

t lea

st o

ne s

ink

for w

ashi

ng h

ands

ava

ilabl

e fo

r use

in th

e ro

om? b

(Y /

N)

3.

Wha

t is

the

tota

l num

ber o

f sin

ks?

(N)

4.Ho

w m

any

sinks

:

a. a

re c

lean

? (n

/N)

b. h

ave

cont

inuo

us su

pply

of c

lean

, run

ning

wat

er?c (

n/N

)

c. ha

ve so

apd a

vaila

ble?

(n/N

)

d. h

ave

singl

e-us

e to

wel

s ava

ilabl

e? (n

/N)

5.W

hat i

s th

e to

tal n

umbe

r of t

oile

ts fo

r pat

ient

s? (N

)

6.Ho

w m

any

toile

ts:

a. a

re fu

nctio

ning

? (n

/N)

b. a

re c

lean

? (n

/N)

New

born

resu

scita

tion

area

7.

How

man

y ot

her r

oom

s ha

ve a

t lea

st 1

resu

scita

tion

area

set

up?

(N)

8.Ho

w m

any

deliv

ery

beds

hav

e a

resu

scita

tion

area

ava

ilabl

e w

ithin

2 m

? (n

/N)

9.

How

man

y re

susc

itatio

n ar

eas

are

avai

labl

e? (N

)

CHECKLIST 3c ENVIRONMENTAL HYGIENE:

Delivery room, recovery room, postnatal care room and neonatal care unit

23

Que

stio

nDe

liver

y ro

om(s

)Re

cove

ry

room

(s)

Neo

nata

l ca

re u

nit

PNC

room

(s)

Com

men

ts

10.

How

man

y re

susc

itatio

n ar

eas:

a. a

re c

lean

and

dry

? (n

/N)

b. h

ave

new

born

am

bu b

ag a

nd m

ask

avai

labl

e? (n

/N)

Sup

plie

s an

d eq

uipm

ent (

Y/N

)

11.

Are

all s

urfa

ces

free

of c

lutte

r?

12.

Are

new

gar

bage

bag

s us

ed fo

r eac

h de

liver

y?e

13.

Are

shar

ps b

oxes

ava

ilabl

e?

14.

At le

ast 1

met

er s

epar

atio

n be

twee

n be

ds?

15.

Clea

n th

erm

omet

ers

and

stet

hosc

opes

and

use

d fo

r eac

h pa

tient

? (s

epar

ate

equi

pmen

t ded

icat

ed to

eac

h pa

tient

; or s

uppl

ies

for c

lean

ing

inst

rum

ents

ava

ilabl

e?e )

Pro

mot

ion

of b

aby

food

com

pany

pro

duct

s

16.

Are

baby

food

com

pany

mat

eria

ls vi

sible

(pos

ters

, bro

chur

es, s

ticke

rs,

pain

ted

wal

ls, c

loth

ing,

etc

.)

17.

Are

hosp

ital o

rder

s pr

ohib

iting

use

of i

nfan

t for

mul

a an

d ot

her l

inka

ges

with

milk

form

ula

com

pani

es v

isibl

e an

d po

sted

som

ewhe

re in

the

area

?

a.

To u

nder

take

a c

ompl

ete

hand

hyg

iene

ass

essm

ent,

see

‘Han

d Hy

gien

e Se

lf-A

sses

smen

t Fra

mew

ork’

(WHO

, 201

0)b.

If

mor

e tha

n one

room

is av

aila

ble i

n a ca

tego

ry, r

epor

t ava

ilabi

lity i

n eac

h roo

m se

para

tely.

Not

e if a

lcoho

l gel

/han

d rub

is av

aila

ble f

or st

aff u

se bu

t not

for u

se by

patie

nts a

nd fa

milie

s.c.

A

wat

er su

pply

that

is e

ither

pip

ed o

r fro

m o

nsite

stor

age,

with

app

ropr

iate

disi

nfec

tion,

mee

ting

appr

opria

te sa

fety

stan

dard

s for

mic

robi

al a

nd c

hem

ical

con

tam

inat

ion.

d.

Soap

: det

erge

nt-b

ased

pro

duct

s th

at c

onta

in n

o ad

ded

antim

icro

bial

age

nts

or m

ay c

onta

in th

ese

sole

ly a

s pr

eser

vativ

es. I

t may

be

in v

ario

us fo

rms

incl

udin

g ba

r so

ap, t

issu

e, le

af a

nd li

quid

pre

para

tions

.e.

Th

ese

ques

tions

are

pre

fera

bly a

nsw

ered

thro

ugh

obse

rvat

ion.

If it

is n

ot p

ossib

le, t

hen

ask

heal

th st

aff.

Indi

cate

‘(R)

’ nex

t to

answ

ers t

hat w

ere

obta

ined

by a

skin

g st

aff.

CHECKLIST 3c ENVIRONMENTAL HYGIENE

Delivery room, recovery room, postnatal care room and neonatal care unit (continued)

24


CHECKLIST 4

Review of availability of key medicines and supplies for EENCCh

eckl

ist 4

. Rev

iew

of a

vaila

bilit

y of

key

med

icin

es a

nd s

uppl

ies

for E

ENC

Avai

labl

e

on th

e da

y

of th

e re

view

? (Y

or N

)

Stoc

k co

nditi

on?

No

expi

red

drug

s?

Equi

pmen

t fun

ctio

nal?

Stoc

k re

cord

s ex

ist?

(Y

or N

)

# St

ock-

outs

in

the

past

12

mon

ths

1.

Mag

nesiu

m s

ulfa

te fo

r sev

ere

pre-

ecla

mps

ia a

nd e

clam

psia

, an

d fe

tal n

euro

prot

ectio

n if

gest

atio

nal a

ge <

32 w

eeks

£ N

orm

al s

tora

ge a

£ N

o ex

pire

d dr

ugs

2.

Oxy

toci

n fo

r IM

and

par

ente

ral u

se –

imm

edia

tely

pos

tpar

tum

–

and

for c

ontro

l of h

aem

orrh

age

£ 2

–8 °

C£

Pro

tect

ed fr

om li

ght b

£ N

o ex

pire

d dr

ugs

3.Co

rtico

ster

oids

for w

omen

of 2

4–34

wee

ks o

f ges

tatio

n at

risk

of

pre

term

del

iver

y c

£ N

orm

al s

tora

ge a

£ P

rote

cted

from

ligh

t b

£ N

o ex

pire

d dr

ugs

4.An

tibio

tics

for p

rete

rm p

rela

bour

rupt

ure

of m

embr

anes

d £

Nor

mal

sto

rage

a

£ P

rote

cted

from

ligh

t b

£ N

o ex

pire

d dr

ugs

5.Fu

nctio

nal n

ewbo

rn a

mbu

bag

and

mas

k (s

izes

0 a

nd 1

) w

ithin

2 m

of e

ach

deliv

ery

bed

6.

Oxy

gen

for n

ewbo

rn u

se

7.CP

AP

8.Fu

nctio

nal a

utoc

lave

9.Re

frige

rato

r

10.

Full

deliv

ery

sets

for d

eliv

ery e

11.

Vita

min

K£

Nor

mal

sto

rage

a

£ P

rote

cted

from

ligh

t b

£ N

o ex

pire

d dr

ugs

25

Avai

labl

e

on th

e da

y

of th

e re

view

? (Y

or N

)

Stoc

k co

nditi

on?

No

expi

red

drug

s?

Equi

pmen

t fun

ctio

nal?

Stoc

k re

cord

s ex

ist?

(Y

or N

)

# St

ock-

outs

in

the

past

12

mon

ths

12.

Hepa

titis

B va

ccin

e£

2–8

°C

£ N

o ex

pire

d dr

ugs

13.

BCG

vac

cine

£

2–8

°C

£ N

o ex

pire

d dr

ugs

14.

Inje

ctab

le a

ntib

iotic

s fo

r man

agem

ent o

f new

born

sep

sis£

Nor

mal

sto

rage

a

£ P

rote

cted

from

ligh

t b

£ N

o ex

pire

d dr

ugs

15.

Baby

cap

s –

and

adeq

uate

clo

ths

for d

ryin

g

16.

Func

tiona

l del

iver

y ta

bles

17.

Surg

ical

glo

ves

18.

At le

ast o

ne ta

ble

or tr

olle

y fo

r set

ting

up:

a. d

elive

ry se

ts

b. r

esus

citat

ion

area

s

a.

Stor

age

in d

ry, w

ell-v

entil

ated

pre

mis

es a

t tem

pera

ture

s of

15–

25 °

C or

, dep

endi

ng o

n cl

imat

ic c

ondi

tions

, up

to 3

0 °C

.b.

O

xyto

cin

(com

pare

d to

met

herg

in) i

s re

lativ

ely

less

ligh

t-se

nsiti

ve b

ut it

is s

till g

ood

prac

tice

to p

rote

ct it

from

ligh

t as

ther

e is

a 7%

loss

in p

oten

cy w

hen

expo

sed

to li

ght i

f sto

red

at 2

1–25

°C.

c.

Re

com

men

ded

whe

n th

e fo

llow

ing

cond

ition

s ca

n be

met

: ges

tatio

nal a

ge a

sses

smen

t can

be

accu

rate

ly u

nder

take

n, p

rete

rm b

irth

is co

nsid

ered

imm

inen

t, th

ere

is no

clin

ical

evi

denc

e of

mat

erna

l inf

ectio

n, a

dequ

ate

child

birt

h ca

re is

ava

ilabl

e, a

nd th

e pr

eter

m n

ewbo

rn c

an re

ceiv

e ad

equa

te c

are

if ne

eded

. d.

Pr

eter

m p

rela

bour

rup

ture

of t

he m

embr

anes

is d

efine

d as

rup

ture

of t

he m

embr

anes

bef

ore

labo

ur h

as b

egun

in a

pre

gnan

cy w

ith a

ges

tatio

nal a

ge o

f les

s th

an

37 w

eeks

.e.

De

fined

loca

lly –

incl

udes

all

mat

eria

ls an

d eq

uipm

ent n

eede

d to

con

duct

a n

orm

al d

eliv

ery.

CHECKLIST 4

Review of availability of key medicines and supplies for EENC (continued)

26


CHECKLIST 5

Review of hospital policies: support of EENC practicesCh

eckl

ist 5

. Rev

iew

of h

ospi

tal p

olic

ies:

sup

port

of E

ENC

prac

tices

Polic

y ar

eaDo

es th

e ho

spita

l ha

ve a

writ

ten

polic

ya ?Ha

ve s

taff

been

orie

nted

on

the

polic

ya ?

1.

Com

pani

on a

nd p

ositi

on o

f cho

ice

for a

ll de

liver

ies

2.

Mat

erna

l and

feta

l mon

itorin

g du

ring

labo

ur in

clud

ing

use

of th

e pa

rtogr

aph

3.M

ater

nal a

nd n

ewbo

rn m

onito

ring

afte

r del

iver

y?

4.Im

med

iate

new

born

car

e:

a. i

mm

edia

te a

nd th

orou

gh d

ryin

gb.

ski

n-to

-ski

n co

ntac

t for

a m

inim

um o

f 90

min

utes

5.Al

l rou

tine

care

(e.g

. eye

car

e, v

itam

in K

, im

mun

izat

ions

and

exa

min

atio

ns) d

elay

ed u

ntil

af

ter a

full

brea

stfe

ed

6.N

on-s

epar

atio

n of

mot

her a

nd b

aby

unle

ss u

rgen

t car

e is

requ

ired

– in

clud

ing

elim

inat

ion

of

neo

nata

l nur

serie

s fo

r wel

l bab

ies

7.

No

rout

ine

suct

ioni

ng

8.N

o pl

acin

g su

bsta

nces

on

the

cord

stu

mp

9.N

o pr

e-la

ctea

l fee

ds

10.

No

bath

ing

until

at l

east

24

hour

s afte

r del

iver

y

11.

EEN

C cli

nica

l poc

ket g

uide

/nat

iona

l clin

ical s

tand

ards

ado

pted

and

use

d fo

r all

deliv

erie

s

12.

Infe

ctio

n co

ntro

l pra

ctic

es fo

r del

iver

ies

incl

udin

g:

a. h

andw

ashi

ng p

ract

ices

b. u

se o

f dou

ble

glov

esc.

pro

cess

ing

cont

amin

ated

inst

rum

ents

d. d

isinf

ectio

n of

del

ivery

bed

s, eq

uipm

ent,

surfa

ces,

floor

s and

oth

er it

ems

e. di

stan

ce o

f sep

arat

ion

of p

atie

nt b

eds/

belo

ngin

gsf.

was

te m

anag

emen

t

13.

Corti

cost

eroi

ds fo

r wom

en o

f 24–

34 w

eeks

of g

esta

tion

at ri

sk o

f pre

term

del

iver

y

14.

Antib

iotic

s fo

r pre

term

pre

labo

ur ru

ptur

e of

the

mem

bran

es (p

PRO

M)

27

Polic

y ar

eaDo

es th

e ho

spita

l ha

ve a

writ

ten

polic

ya ?Ha

ve s

taff

been

orie

nted

on

the

polic

ya ?

15.

Antid

ote

for m

agne

sium

sul

fate

toxi

city

for m

anag

emen

t of p

re-e

lam

psia

and

ecl

amps

ia

(10%

cal

cium

glu

cona

te)

16.

Inje

ctab

le a

ntih

yper

tens

ive

for m

anag

emen

t of p

re-e

clam

psia

and

ecla

mps

ia (H

ydra

lazin

e 5

mg)

17.

Inje

ctab

le a

ntib

iotic

s fo

r man

agem

ent o

f man

ual r

emov

al o

f the

pla

cent

a (a

mpi

cilli

n or

firs

t-ge

nera

tion

ceph

alos

porin

)18

. KM

C fo

r pre

term

bab

ies

wei

ghin

g ≤

2000

g a

t birt

h in

clud

ing

feed

ing

with

bre

ast m

ilk

and

mon

itorin

g fo

r com

plic

atio

ns

19.

Stan

dard

cas

e-m

anag

emen

t gui

delin

es fo

r the

man

agem

ent o

f new

born

sep

sis

20.

Crite

ria fo

r ind

ucin

g or

aug

men

ting

labo

ur

21.

Crite

ria fo

r con

duct

ing

caes

area

n se

ctio

ns

22.

Rest

ricte

d cr

iteria

for c

ondu

ctin

g ep

isiot

omy

for v

agin

al d

eliv

erie

s

23.

Stab

iliza

tion

of n

ewbo

rns

incl

udin

g pr

even

tion

of h

ypot

herm

ia, h

ypog

lyca

emia

, hyp

oxae

mia

, ap

noea

and

infe

ctio

n pr

ior t

o tim

ely

refe

rral

24.

For b

abie

s w

ith re

spira

tory

dist

ress

:

a. o

xyge

nb.

con

tinuo

us p

ositi

ve a

irway

pre

ssur

e (C

PAP)

25.

Care

of s

erio

usly

ill n

ewbo

rn in

fant

s

26.

Patie

nt–s

taff

ratio

s fo

r:

a. d

elive

ry ro

om

b. p

ostp

artu

m w

ard

c. n

eona

tal c

are

unit

27.

Proh

ibiti

on, p

rom

otio

n, sa

les,

and

use

of in

fant

form

ula

or a

ny li

nkag

es w

ith fo

rmul

a co

mpa

nies

in

the

facil

ity

28.

Fam

ily p

lann

ing

coun

selli

ng b

efor

e di

scha

rge

29.

Rout

ine

repo

rting

of s

tillb

irths

, mat

erna

l dea

ths

and

new

born

dea

ths

a.

If ho

spita

l pol

icie

s ar

e no

t ava

ilabl

e, c

heck

for a

vaila

bilit

y of

writ

ten

natio

nal p

olic

ies

at th

e ho

spita

l and

if s

taff

wer

e or

ient

ed o

n it.

CHECKLIST 5

Review of hospital policies: support of EENC practices (continued)

28


Type of health professional

Total #Total

coachedStill to coach

Person responsible for coaching

TimelineOther

resources needed

Total

CHECKLIST 6

EENC coaching summary

29

Indicator Data by yearCountry target

20202015 2016 2017 2018 2019

1. Neonatal care unit / nursery admission rate

2. Proportion of newborn infants by weight:

• < 1000 g

• 1000–1499 g

• 1500–1999 g

• 2000–2499 g

• 2500–3500 g

• > 3500 g

3. Proportion of newborn infants delivered at the facility classified with newborn sepsis a

4. Proportion of newborn infants delivered at the facility classified with birth asphyxia b

5. Newborn mortality rate stratified by weight:

• < 1000 g

• 1000–1499 g

• 1500–1999 g

• 2000–2499 g

• 2500–3500 g

• > 3500 g

6. Case-fatality rate (% registered cases dying)

a. Preterm c newborn infants

b. Low-birth-weight d newborn infants

c. Newborn sepsis

d. Newborn asphyxia

a. Bacterial sepsis of the newborn: ICD-10 P36 (including codes P36.0 – P36.9 bacterial sepsis of known cause or sepsis of unknown cause).

b. Birth asphyxia is defined as newborn infants who are gasping or not breathing at 1 minute of age. c. Preterm newborn infants are live births less than 37 completed weeks gestation (ICD-10 P07.2 and ICD-10 P07.3).d. Low-birth weight is defined as < 2500 g.

CHECKLIST 7a

EENC hospital impact indicators

30


IndicatorAre data

available? Y or N

Details of observed trend

Reasons for observed performance

Neonatal care unit / nursery admission rate

Proportion of newborn infants by birth weight

Proportion of newborn infants with sepsis

Proportion of newborn infants with asphyxia

Newborn mortality by birth weight

Case-fatality rate for sepsis

Case-fatality rate for asphyxia

Case-fatality rate for preterm babies

Case-fatality rate for low-birth-weight babies

CHECKLIST 7b

Progress in EENC hospital impact indicators in the previous 12 months

introducing and sustaining eenc in hospitals: routine...

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