rapid 24 june 6 july, 2013 assessment district bhiwani · 24 june – 6 july, 2013 district bhiwani...

Child Health Division, NRHM, Haryana

in technical collaboration with

RAPID

Assessment

24 June – 6 July, 2013

District Bhiwani

Facility Readiness Assessment for

Essential Newborn Care and Resuscitation

1

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

5. Quantitative findings of facilities 5-11

6. Qualitative findings of facilities

6 a. General Hospital, Bhiwani 20-21

6 b. GH, Charkhi Dadri 22

6 c. GH, Devrala 22

6 d. GH,Bhawani Khera 23

6 e. GH,Shivani 23

6 f. ESI Hospital 23

6 g. CHC Gopi 24

6 h. CHC Bondkalan 24

6 i. CHC Jhojhukalan 25

6 j. CHC Loharu 25

6 k. CHC Dhanana 26

6 l. CHC Miran 26

6 m. CHC Tosham 27

6 n. CHC Manheru 27

6 o. CHC Kairu 28

6 p. PHC Bahal 28

6 q. PHC Bamla 28

6 r. PHC Bhadhra 29

6 s. PHC Gurera 30

6 t. PHC Alakhpur 30

6 u. PHC Jhumpakalan 30

6 v. PHC Kadma 31

6 w. PHC Lilus 31

6 x. PHC Harodi 32

6 y. PHC Sui 32

6 z. PHC Chang 33

6 aa. PHC Bhushan 33

6 ab. PHC Chappar 34

6 ac. PHC Dhani Jamalpur 34

6 ad. PHC DHani Mahu 35

6 ae. PHC Dhigava 35

6 af PHC Dinod 36

6 ag PHC Kharak Kalan 37

6 ah PHC Mai Kalan 37

2

6 ai PHC Manakawas 38

6 aj PHC Pur 38

6 ak PHC Ranila 38

6 al PHC Santokpura 39

6 am PHC Sanwar 40

6 an PHC Sohansada 40

6 ao PHC Talu 41

6 ap PHC Nakipur 41

6 aq PHC Biran 42

6 ar PHC Achina 42

6 as PHC Sandhwa 42

6 at PHC Chiriya 43

6 au SC Dangkalan 43

6 av SC Mandhana 44

6 aw SC Durjanpur 44

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 job trainings to the service providers on novelties in essential newborn care and

resuscitation.

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.

3

Our teams visited 50 facilities in the district, from 24th June, 2013 to 6th July, 2013 including

General Hospitals, ESI Hospital 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, Bhiwani

2. GH, Charkhi Dadri

3. GH, Devrala

4. GH,Bhawani Khera

5. GH,Shivani

6. ESI Hospital

7. CHC Gopi

8. CHC Bondkalan

9. CHC Jhojhukalan

10. CHC Loharu

11. CHC Dhanana

12. CHC Miran

13. CHC Tosham

14. CHC Manheru

15. CHC Kairu

16. PHC Bamla

17. PHC Bahal

18. PHC Bhadhra

19. PHC Gurera

20. PHC Alakhpur

21. PHC Lilus

22. PHC Harodi

23. PHC Sui

24. PHC Chang

25. PHC Bhusan

26. PHC Chappar

27. PHC Dhani Jamalpur

28. PHC Dhani Mahu

29. PHC Dhigawa

30. PHC Dinod

31. PHC Jhumpakalan

32. PHC Juikalan

33. PHC Kadma

34. PHC Kharak kalan

35. PHC Maikalan

36. PHC Manakawas

37. PHC Pur

4

38. PHC Ranila

39. PHC Santokpura

40. PHC Sanwar

41. PHC Sohansada

42. PHC Talu

43. PHC Nakipur

44. PHC Biran

45. PHC Achina

46. PHC Sandhwa

47. SC Chiriya

48. SC Dangkalan

49. SC Mandhana

50. SC Durjanpur

The findings of district Bhiwani in general are as follows:

1. Availability of infrastructure and supplies in most of the facilities.

2. Trainings of newly recruited staff nurses for SBA and NSSK

3. Refreshers for trained staff nurses

4. Baby clothes (clean sheets for drying and wrapping newborns) are not available in

most of the facilities.

5. Birth dose Hepatitis-B, BCG and Vitamin K not given at the time of birth.

6. Room thermometers to know the exact temperature of the delivery room are not

available in most of the facilities. Low reading clinical thermometers (alcohol

thermometers) to check the temperature of newborns are not available.

7. Vitamin K for newborn is not available in many facilities.

8. Disposable D Lee Mucus Extractors are cheap and best devised for suction when

electric or foot operated suction machines are either not available or cannot be used,

but in most of the facilities Disposable D Lee Mucus Extractors are not available.

9. Effective hand washing (washing hands following six golden steps) before delivery is

not in practice.

10. Record of essential services provided to the newborn immediately after birth is not

kept at any of the facilities. Baby notes on essential newborn care are not maintained.

11. Use of double gloves during delivery and newborn care process is not in practice.

12. Use of oxytocin for induction/augmentation of labour is still in practice which has to

be discouraged.

13. In most of the facilities suction of every new born, regardless of her/his condition, is

rampantly in practice.

14. Even after widespread campaign for exclusive breast feeding and initiation of early

breast feeding (within one hour of birth), the breastfeeding usually begins after one

hour of birth in most of the facilities.

5

15. Thermal care is considered as one of the most important component of essential

newborn care which is best advocated through skin-to-skin contact between mother

and newborn, but not in practice in majority of facilities.

16. There is standard infection prevention protocols for disinfection and sterilization of

the equipment and instruments used routinely but in most of the facilities these

protocols are not being adhered to.

17. Rational and adequate display of Information, Education& Communication (IEC)

materials and Job Aids is essential to reflect the correct message to the beneficiaries

as well as to the providers, this was lacking in majority of the facilities.

18. The bed head tickets or Case sheets are not available in the delivery huts.

19. Knowledge of service providers for essential newborn care and resuscitation has room

for great improvement.

20. The skills required for essential newborn care and resuscitation have been found

below average in general. The chronology of these skills is of paramount importance

and needs repeated refresher trainings.

6

Table 1. Quantitative Results and Scores (>75 Good, 50-75 Average, <50 Poor)

Name of

Facility

Infrastru

cture

DELIV

ERY

AND

NEWB

ORN

CARE

SERVI

CES

ESSENTI

AL

DRUG

EQUIPM

ENT

AND

SUPPLY

PROTOC

OLS

AND

GUIDELI

NES

Register

s and

Case

records

complete

ness

PROVID

ER

K0WLE

DGE

AND

SKILL

FACIL

ITY

OVER

ALL

AVER

AGE

PHC

SANWAR 81 75 64 53 56 46 62

PHC

DINOD 75 65 63 53 62 53 62

GH Bhiwani

Khera 88 70 76 41 63 28 61

PHC

JUIKALAN 73 70 69 35 67 51 61

CHC Jojhu

kalan 88 75 64 29 56 49 60

PHC

MAIKALA

N

71 70 69 41 49 61 60

CHC

TOSHAM 88 75 67 29 58 39 59

SDH

DADRI 87 75 64 47 37 45 59

PHC

SOHANSA

DA

71 70 69 35 49 60 59

PHC

Gurera 67 75 67 41 58 41 58

7

CHC

Manheru 79 75 65 41 41 47 58

PHC

SANTOKP

URA

79 75 61 53 39 37 57

Name of

Facility

Infrastru

cture

DELIV

ERY

AND

NEWB

ORN

CARE

SERVI

CES

ESSENTI

AL

DRUG

EQUIPM

ENT

AND

SUPPLY

PROTOC

OLS

AND

GUIDELI

NES

Register

s and

Case

records

complete

ness

PROVID

ER

K0WLE

DGE

AND

SKILL

FACIL

ITY

OVER

ALL

AVER

AGE

PHC Dhani

Jamalpur 85 75 69 41 45 29 57

District

Average 72 67 61 37 35 39 52

PHC

MANKAW

AS

79 75 61 53 24 50 57

GH Bhiwani 98 75 76 29 9 52 57

PHC

CHHAPAR 71 70 70 53 18 56 56

CHC

BONDKAL

AN

67 65 64 41 54 46 56

PHC Chang 62 75 67 53 52 28 56

PHC Biran 75 75 58 35 63 30 56

PHC

Kharak 79 75 65 41 39 30 55

8

kalan

GH Shiwani 77 70 56 35 63 28 55

PHC

KADMA 77 70 55 29 44 52 55

CHC Kairu 73 65 70 35 47 31 53

CHC

JHUMPAK

ALAN

58 65 57 29 62 49 53

Name of

Facility

Infrastructu

re

DELIVER

Y AND

NEWBOR

N CARE

SERVICE

S

ESSENTIA

L DRUG

EQUIPME

NT AND

SUPPLY

PROTOCO

LS AND

GUIDELIN

ES

Registers

and Case

records

completene

ss

PROVIDE

R

K0WLEDG

E AND

SKILL

FACILIT

Y

OVERAL

L

AVERAG

E

PHC

Alakhpura 63 80 63 47 18 46 53

PHC Harodi 65 70 72 29 49 28 52

District

Average 72 67 61 37 35 39 52

PHC

BAMLA 65 70 58 35 48 36 52

District

Average 72 67 61 37 35 39 52

PHC

Nakipur 81 75 47 35 50 23 52

PHC Badra 71 75 63 53 0 49 52

PHC

BAHAL 69 70 61 35 35 38 52

CHC

MIRAN 71 70 60 35 34 34 51

9

PHC Ranila 81 75 61 24 41 23 51

PHC TALU 56 50 62 24 48 60 50

PHC

BARWA 69 70 61 35 26 35 49

CHC Gopi 81 60 65 29 9 52 49

Phc

Dhigawa 71 65 53 35 48 23 49

CHC

Dhanana 79 60 65 29 9 52 49

GH Devrala 63 55 50 41 49 35 49

Name of

Facility

Infrastructu

re

DELIVER

Y AND

NEWBOR

N CARE

SERVICE

S

ESSENTIA

L DRUG

EQUIPME

NT AND

SUPPLY

PROTOCO

LS AND

GUIDELIN

ES

Registers

and Case

records

completene

ss

PROVIDE

R

K0WLEDG

E AND

SKILL

FACILIT

Y

OVERAL

L

AVERAG

E

PHC

Bhusan 67 75 55 41 18 37 49

District

Average 72 67 61 37 35 39 52

PHC Dhani

Mahu 69 65 58 35 34 27 48

PHC Lilus 75 50 65 29 9 52 47

PHC Sui 75 50 65 29 9 52 47

PHC Achina 75 65 68 24 0 34 44

SC

Mandhana 56 70 51 41 0 39 43

SC DANG

KALAN 62 65 50 29 0 39 41

10

PHC Puri 42 60 45 12 42 24 38

SC

CHIRIYA 52 55 47 29 0 34 36

PHC

Sandwa 48 50 48 29 0 12 31

PHC

BALKARA 56 0 59 35 0 0 25

Graph 1. Over All Grading Of Facilities in % for Facility (GH,SDH,CHC) readiness and ENCR

Graph II. Over All Grading Of PHC in % for Facility readiness and ENCR

56 56 54 53 5047 45

42 41 40 37 3733 32

27

13

Over All Grading of facilities in % scoring for facility readiness and ENBC/R

11

Graph III. Over All Grading of Sub Centers in % for Facility readiness and ENCR

62626160595857575756565655555352525252525251504949494847474438

3125

0

20

40

60

80

100

52

43 4136

0

20

40

60

80

100

DistrictAverage

SCMandhana

SC DANGKALAN

SC CHIRIYA

20

39 39 3934

0

20

40

60

80

100

SC Mandhana SC DANGKALAN

District Average SC CHIRIYA

21

Qualitative Findings of Individual Facilities

General Hospital, Bhiwani

GH, Charkhi Dadri

GH, Devrala

GH,Bhawani Khera

GH,Shivani

ESI Hospital

CHC Gopi

CHC Bondkalan

CHC Jhojhukalan

CHC Loharu

CHC Dhanana

CHC Miran

CHC Tosham

CHC Manheru

CHC Kairu

PHC Bamla

PHC Bahal

PHC Bhadhra

PHC Gurera

PHC Alakhpur

PHC Lilus

PHC Harodi

PHC Sui

PHC Chang

PHC Bhusan

PHC Chappar

PHC Dhani Jamalpur

PHC Dhani Mahu

PHC Dhigawa

PHC Dinod

PHC Jhumpakalan

PHC Juikalan

PHC Kadma

PHC Kharak kalan

1. General Hospital, Bhiwani

i. Uninterrupted power supply is not available in labour room.

ii. In case of caesarean section, if any complication to newborn arises, baby is taken to the

SNCU i.e. no radiant warmer available in the OT, only 200W bulb present.

iii. JSSK diet given at 2 regular timings – morning and evening. This results in non availability of

diet to the mother delivering between 8pm to 10 am.

iv. The staff nurses in the labour room do not provide any care at all to the newborn, instead a

staff nurse from Sick Newborn Care Unit (SNCU) is called just before delivery to receive the

newborn and take care of her/him.

v. Bag and mask in the labour room was found in pathetic condition (lots of blood stains)

vi. Case Records, registers, partographs incompletely filled.

22

Skills and Practices:

i. Staff nurses who are posted in the labour room lacks essential new born and resuscitation

skills.

ii. There is no birth preparedness in the labour room, before any delivery.

iii. Immediate cord cutting is in practice after milking of cord.

iv. Immediate Skin to skin contact is not practiced.

v. Every new born is being taken to NBCC despite of their condition, for suctioning.

Few Issues Related to Yashoda in General Hospital, Bhiwani

i. Yashodas’ are compelled to do jobs (dusting of tables, washing of floors etc.) which are not

proposed for them by UNOPS-NIPPI.

ii. Yashodas were deputed by labor room in-charge to clean surgical instruments.

iii. Yashodas were involved in procedures like cord clamping and cord cutting which also is not

included in job responsibilities of Yashoda.

a) Every baby delivered is handed over to yashoda for new born care.

b) Yashoda clamps the cord in the radiant warmer(as instructed).

c) Suction, Stimulation is done by yashoda and if there is any suspected emergency then the

staff nurse attends the baby.

iv. Duty roster for Yashoda as recommended by NIPI is not being followed at the facility.

Recommendations

i. Birth preparedness is an integrated part of essential newborn care and should be done as per

protocols; so, please switch on the radiant warmer half an hour before delivery with two clean

sheets placed underneath for pre-warming regardless of weather. Maintain room temperature

between 25oC to 30oC. Switch off the fans to avoid direct air draught to the newborn. Prepare

the tray with necessary instruments, equipment, drugs and two pairs of disposable gloves,

cord clamps and mucous extractor. Check for availability and functionality of sterilized self-

inflating bag and mask (0, 1).

ii. Make the Newborn Care Corner functional; the radiant warmer is for the thermal care of a

newborn and not to keep anything else than newborn care instruments, so, remove shaving

razors and spanner from there with immediate effect.

iii. Labour room nurses are well trained for conducting deliveries as well as essential newborn

care and if required, resuscitation. There seems no need to call a SNCU staff nurse to take

care of every newborn. Call SNCU nurses only when there is doubt of some newborn

complication.

iv. Bag and masks (0, 1) provided in the labour room is for emergency and immediate

resuscitation of the newborn; it has to be sterilized/autoclaved after every use.

v. Make it a practice/advocate to cut cord between 1 to 3 minutes of birth with disposable

surgical blade in case the newborn vitals are within normal limits.

vi. Skin to skin contact is best for thermal care of baby; it has to be provided to each and every

normal newborn immediately after birth.

vii. Yashodas have been appointed for counseling and support of the mother before, during and

after delivery and not for issuing patient registration slips or making queues, clamping and

cutting cord, giving out reports in laboratory and cleaning of surgical instruments. Yashodas

must only be used for the work they are appointed for.

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2. GH Charkhi Dadri

i. Vitamin K is not administered in the facility.

ii. There were no registers of Stabilizing Unit available at the time of visit.

iii. Only 1 child stabilized in last 2 months due to lack of training.


i. All staff nurses are NSSK trained but lack resuscitation skills.

ii. Milking of the cord and immediate cord cutting is in the practice.

iii. Suctioning and Clamping is done at the radiant warmer.

iv. Skin to skin contact is not in practice.

v. Partograph and Baby notes are incompletely filled.

Recommendations

i. Stabilizing Unit register should be available.

ii. Documentation of essential new born care must be done. Which includes documentation of

cord clamping, cutting with sterile blade, immediate drying & wrapping and immediate breast

feeding is done or not.

iii. Start giving Vitamin K to every newborn (1 mg to full term and 0.5 mg to pre-term neonates).

iv. Make it a practice/advocate to cut cord between 1 to 3 minutes of birth with disposable


v. Skin to skin contact is best for thermal care of baby; it has to be provided to each and every


vi. Make it a practice/advocate to cut cord between 1 to 3 minutes of birth with disposable


3. GH Devrala

i. Newborn care corner was not established till the day of visit (neither Radiant Warmer nor 200

wt bulb is available).

ii. Room thermometer is not available in Labour room.

iii. Vitamin K administration is not in practice.

iv. Autoclave is available but non-functional, so it fails infection prevention.

v. Doppler is available but it is not functional.

vi. No staff nurse or ANM is trained for NSSK.

Recommendations

i. A separate area marked as NBCC must be established in labour room. It should contain

warming equipments. Make it functional;for the thermal care of a newborn.

ii. Start giving Vitamin K to every newborn (1 mg to full term and 0.5 mg to pre-term neonates).

iii. Make the Doppler functional as soon as possible.

iv. Make autoclave equipment functional. It is very important for preventing infection.





vii. Make it a practice/advocate to cut cord between 1 to 3 minutes of birth with disposable


24

4. GH Bhiwani Khera

Vitamin K injection is not given at birth in the facility.


i. Immediate Cord cutting after milking the cord is practiced.

ii. Suctioning of every newborn is in practice despite the condition of the newborn.

iii. Skin to skin contact is not in practice and every newborn is shifted to radiant warmer.

iv. Skills for neonatal resuscitation is lacking in its chronological order.

Recommendations:

i. Start giving Vitamin K to every newborn (1 mg to full term and 0.5 mg to pre-term neonates).

ii. Discourage milking of cord and suction for every newborn.

iii. Make it a practice/advocate to cut cord between 1 to 3 minutes of birth with disposable


iv. Skin to skin contact is best for thermal care of baby; it has to be provided to each and every


5. GH Shivani


i. Immediate Cord cutting after milking the cord is practiced.

ii. Suctioning of every newborn is in practice despite the condition of the newborn.

iii. Skin to skin contact is not in practice and every newborn is shifted to radiant warmer.

iv. Skills for neonatal resuscitation is lacking in its chronological order.

Recommendations:

i. Make it a practice/advocate to cut cord between 1 to 3 minutes of birth with disposable


ii. Skin to skin contact is best for thermal care of baby; it has to be provided to each and every


iii. Discourage milking of cord and suction for every newborn.

6. ESI Hospital

i. New born care corner was not maintained according to the protocols.

ii. Zero number size Mask was not available at the NBCC.

iii. Vitamin k is not being administered to every newborn.


i. There is practice of receiving newborn in tray.

ii. Immediate Cord cutting after milking the cord is practiced.

iii. Suctioning of every newborn is in practice despite the condition of the newborn.

iv. Skin to skin contact is not in practice and every newborn is shifted to radiant warmer.

Recommendations

i. Start giving Vitamin K to every newborn (1 mg to full term and 0.5 mg to pre-term neonates).

ii. Mask of both sizes 0 and 1 should be available.

iii. A separate area marked as NBCC must be established in labour room. It should contain

warming equipments. Make it functional; for the thermal care of a newborn

25



7. CHC Gopi

i. Hygiene and privacy are maintained in the Delivery Room.

ii. Delivery Register/Diet Register/ANC Register all are updated and maintained.

iii. IEC for maternal and newborn care are well displayed in the labour room.

iv. Birth doses of Polio, BCG and Hep.B are administered at the birth to the newborn.

v. Vitamin K is available but not administered to every child at birth.

vi. Mucous Extractor is available in the store but not utilized.


i. Nurses that are NSSK trained lack resuscitation skills.

ii. Partograph and Baby notes incompletely filled.

iii. Immediate cord cutting is in practice and cord clamping is done at the radiant warmer.

iv. Every baby is taken to the radiant warmer and suction of every baby is done.

v. Skin to skin contact is not in practice.

Recommendations:

i. Skin to skin contact is best for thermal care of baby; it has to be provided to each and every


ii. Start giving Vitamin K to every newborn (1 mg to full term and 0.5 mg to pre-term neonates).

iii. Make proper use of disposable D .L. mucous extractor for suctioning of baby

iv. Write notes on essential newborn care in case records.



8. CHC Bondkalan

i. Double gloving is not in practice.

ii. Delivery instruments found rusted at the time of the visit.

iii. Water for hand washing is not available in the delivery room.

iv. Infection prevention protocols are not being followed.

v. Record keeping needs improvements in case records.


i. Chronology of essential new born care is not clear to staff.

ii. Immediate cord cutting and milking of cord is in practice.

iii. Skin to skin contact is not practiced.

i. Shifting all baby to the NBCC immediately after birth irrespective of newborn’s condition.

Recommendations

i. Infection prevention should be followed strictly according to the protocols.

ii. Rusted instruments should be replaced with new instruments.



iv. Suction is not required in newborns with good cry and normal respiration at birth; stop

suction of every newborn.

26





9. CHC Jhojhu Kalan

i. Labour room staff not aware about operating of suction machine and radiant warmer.

ii. Administration of Vitamin K is not in practice.


i. Milking and Immediate cord cutting is a usual practice.

ii. Every baby was separated from mother and taken to Radiant Warmer.

iii. Knowledge and skills of providers for newborn care and resuscitation are below average.

Recommendations:

i. Discourage milking of cord and suction for every newborn.

ii. Make it a practice/advocate to cut cord between 1 to 3 minutes of birth with disposable


iii. Skin to skin contact is best for thermal care of baby; it has to be provided to each and every


iv. Start giving Vitamin K to every newborn (1 mg to full term and 0.5 mg to pre-term neonates).

10. CHC Loharu

i. Surgical blade is not available for cord cutting.

ii. Hand washing is not done properly.

iii. Oxytocin administration during labour is in practice.

iv. Partographs are not being filled.


i. Newborn is held by legs and hanged in head down position.

ii. There is practice of immediate cord cutting.

iii. There is practice of milking of cord.

iv. Transferring every child to the new born care corner is in practice.

v. Skin-to-skin contact is not practiced between mother and child.

vi. Resuscitation skills were average.

Recommendations:

i. The practice of hanging the newborn upside down should stop immediately.

ii. Hand washing is an integral part of infection prevention so it should be done with six steps.






vi. Start giving Vitamin K to every newborn (1 mg to full term and 0.5 mg to pre-term neonates).

27

11. CHC Dhanana

i. Delivery Sets and other instruments are autoclaved regularly.

ii. Delivery Register/Diet Register/ANC Register all are updated and maintained.

iii. Birth doses of Polio, BCG and Hepatitis B are administered at birth.


i. Immediate cord cutting is in practice and clamps applied to the cord at the radiant warmer.

ii. Skin to skin contact is not in practice.

iii. Every baby is taken to the radiant warmer and suction of every baby is done.

iv. Staff Nurses lack resuscitation skills.

v. Vitamin K available but not administered to every child at birth.

vi. Partograph and Baby notes incompletely filled.

Recommendations:

i. Partograph and Baby notes should be duly filled.








12. CHC Miran

i. Hand washing is not done properly.

ii. Surgical blade is not available for cord cutting.

iii. Vitamin K is not being administrated at birth.


i. Newborn is held by legs and hanged in head down position

ii. There is practice of milking of the cord and immediate cord cutting.

iii. Transferring every child to the new born care corner is in practice.

iv. Skin-to-skin contact is not practiced between mother and child.

v. Staff nurses were average Resuscitation skills.

vi. Partographs are not being filled properly.

Recommendations:

i. Partograph and Baby notes should be duly filled.








28

13. CHC Tosham

i. Delivery instruments found in rusted state during the visit.

ii. Infection prevention protocols are not being followed.

iii. Record keeping needs improvements in case records.



ii. Immediate cord cutting and milking of cord is in practice.


iv. Shifting all newborn to the NBCC immediately after birth irrespective of newborn’s

condition.

v. Chronology of the essential new born care is not clear to staff nurse.

Recommendations:

i. Hand washing is an integral part of infection prevention so it should be done with six steps.






v. Start giving Vitamin K to every newborn (1 mg to full term and 0.5 mg to pre-term neonates).

14. CHC Manheru

i. Room thermometer is not available.

ii. Radiant warmer is available but not functional.


i. Immediate cord cutting is in practice.

ii. Shifting all babies to the NBCC immediately after birth.

iii. Skin to skin contact is not in practice.

iv. Skills related to resuscitation are not in chronological order.

v. Infection prevention practices are not followed.

Recommendations:

i. Radiant warmer should be made functional as soon as possible.








29

15. CHC Kairu

i. Bed head tickets needs to be improved with procedures done on newborn and mother both eg.

Drying, wrapping, use of surgical blade, injection Oxytocin etc. with dosage and time of

administration.

ii. Room thermometer was not available in labour room.

iii. Radiant warmer and Wall clock are out of order.

Recommendations:

i. If delivery and newborn care services are not possible in this facility, shift the radiant warmer

and other equipment to some other facility where these can be utilized.

ii. Autoclaving of Bag & Mask is recommended.

16. CHC JOJHU KALAN


i. Immediate Cord cutting and milking of the cord are in practice.

ii. Staff nurse is taking every newborn to warmer doing suctioning of every newborn.

iii. Skin to skin contact is not in practice.

iv. Staff nurse lacks in skills for neonatal resuscitation in chronological order.

Recommendations:








17. PHC BAHAL

i. Zero number size Mask is not available.

ii. Surgical blade for cord cutting is not available.

iii. Hand washing is not done properly.


i. Oxytocin administration is done during labour is in practice.

ii. There is practice of milking and immediate cutting of the cord.

iii. Skin-to-skin contact is not practiced between mother and child.


v. Resuscitation skills were average.


Recommendations:

i. Ensure availability of Surgical Blade and Zero and One number size with Bag & Mask.





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18. PHC BAMLA

i. Vitamin K is not administered in proper dose.

ii. Hygiene level in delivery room is poor.

Skills and practices:

i. Hand washing is not done properly before the delivery.

ii. Staff nurses were not able to wear gloves properly.

iii. There is practice of milking of cord



vi. Resuscitation skills were average.

vii. Partographs were not being filled properly.

Recommendations:


ii. Ensure the strict implementation of the infection prevention protocols.







19. PHC Bhadhra

i. Room thermometer is not available.

ii. Proper hygiene, sanitation, and cleanliness is not maintained for labour room.

iii. Zero no. Mask is not available for resuscitation.

iv. Wall clock was non-functional in labor room.

v. Radiant warmer was non-functional.

Recommendations:

i. Room thermometer and Zero no.mask should be available.

ii. Cleanliness should be maintained in the labour room.

iii. Hand washing is an integral part of infection prevention so it should be done with six steps.

iv. Ensure the strict implementation of the infection prevention protocols.

v. Discourage milking of cord and suction for every newborn.



vii. Skin to skin contact is best for thermal care of baby; it has to be provided to each and every


viii. Start giving Vitamin K to every newborn (1 mg to full term and 0.5 mg to pre-term neonates).

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20. PHC GURERA

i. Drugs need to be stored in refrigerator were kept outside of it.

ii. Autoclave of delivery instruments was not done at the time of visit.

iii. Bed head tickets needs to be filled completely, mentioning procedures, with information

related to baby and mother.

Recommendations:

i. Room thermometer and Zero number mask should be available.

ii. Cleanliness should be maintained in the labour room.









21. PHC ALAKHPUR

i. Oxygen cylinder was non-functional at the time of visit.

ii. Bag & Mask was out of function as pop up value was not working well.

iii. There was presence of pungent smell in the labour room due to placental waste placed in open

for more than 7 hours of duration. (Outside the yellow bag, without cover).

iv. Delivery instruments (should be put inside the drum, after autoclave), were placed in open.

Recommendations:

i. Cleanliness and hygiene should be maintained in the labour room according to the protocols.

ii. Delivery instruments should not be removed from the drum, after autoclaving.









22. PHC JHUMPA KALAN

i. The delivery instruments are found in rusted condition.

ii. Autoclave machine available at the facility is not in functional state.

iii. NBCC established, need to replace old Radiant warmer, which is not functional.

iv. Phototherapy machine need to be move to its desired place (SU or SNCU).

v. Electric suction machine does not have functional pressure gauge.

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ii. Chronology of essential new born care is not clear to the staff.

iii. Immediate cord cutting and milking of cord in practice.

iv. Shifting all baby to the NBCC immediately after birth irrespective of newborn’s condition.

v. Skin to skin contact is not practiced.

vi. Administration of Vitamin K is not in practice.

vii. Knowledge is poor about disinfection of equipments.

Recommendations:







23. PHC KADMA

i. Record keeping & documentation is very good.

ii. Knowledge and motivation of staff is good.

iii. Mechanism to ensure non use of expired drugs well displayed in labour room.


i. Partograph are being filled correctly.

ii. Immediate cord cutting and milking of cord in practice.


iv. Shifting all baby to the NBCC immediately after birth despite good cry.

v. Resuscitation steps not in chronological order.

Recommendations:







24. PHC Lilus

i. There is need for proper rationalization of population.

ii. It is not a 24x7 delivery point.

iii. There are only 10 deliveries conducted in last 6 months.


i. Staff nurse posted in the facility lack skills of essential new born care and resuscitation.

ii. Vitamin K is out of stock and not being administered.

iii. Skin to skin contact not practiced between mother and child immediately after delivery.

iv. Every newborn is taken to the new born corner post delivery after immediate cord cutting.

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Recommendations:

i. Ensure the availability of Vitamin K and administration to the newborns.

ii. Oxytocin should be administered as AMTSL, not for augmentation.

iii. 6 step hand wash is to be done as readiness before delivery.

iv. Double gloving is advised as mandatory requirement for infection prevention.







25. PHC Harodi

i. There are two warmers and one phototherapy unit available in the facility.

ii. Bed head tickets need to be more updated with procedures.


i. Knowledge of staff nurses is good regarding essential new born care and resuscitation.

ii. Newborn care practices followed in the facility are appreciable.

Recommendations:

i. Extra equipments lying unused in the facility can be shifted to where it is needed.










26. PHC Sui

• Vitamin K is out of stock and no administration to the newborns.


i. Immediate cord cutting and milking of cord is in practice at the facility.

ii. Skin to skin contact is not practiced and taking every newborn to the radiant warmer.

iii. Staff nurse lacks in skills of essential new born care and resuscitation.

Recommendations:

i. Ensure the availability and administration of Vitamin K at the facility.







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27. PHC Chang

i. One radiant warmer and one phototherapy unit were available.

ii. Shoulder role was not available at newborn care corner.


• Overall skills were good of staff nurses regarding essential newborn care and resuscitation.

Recommendations:

i. Oxytocin should be administered as AMTSL, not for augmentation.

ii. 6 step hand wash is to be done as readiness before delivery.

iii. Double gloving is advised as mandatory requirement for infection prevention.

iv. Discourage milking of cord and suction for every newborn.





vii. Start giving Vitamin K to every newborn (1 mg to full term and 0.5 mg to pre-term neonates).

28. PHC BHUSAN

i. Delivery load is around 2-3/month.

ii. There is excessive stock of Vitamin K and Oxytocin in the facility.

iii. Weighing machine and Bag & Mask available in the facility found soiled at the time of visit.

iv. Zero number Mask is not available with Bag and Mask.

v. Same mucous extractor is used for suction in every newborn.


i. Milking of cord and immediate cord cutting is in the practice.

ii. Skin to skin contact is not practiced and every newborn is shifted to the radiant warmer.

iii. Suction is done for every newborn.

Recommendations:

i. Extra stock of Vitamin K and Oxytocin should move to other sites where it is needed.

ii. Hygiene Level is not negotiable and hence should be maintained according to the protocols.

iii. Ensure the adequate availability of Mucous Extractor as it is a disposable item and should not

be reused.

iv. Oxytocin should be administered as AMTSL, not for augmentation.

v. 6 step hand wash is to be done as readiness before delivery.

vi. Double gloving is advised as mandatory requirement for infection prevention.

vii. Discourage milking of cord and suction for every newborn.

viii. Make it a practice/advocate to cut cord between 1 to 3 minutes of birth with disposable


ix. Skin to skin contact is best for thermal care of baby; it has to be provided to each and every


x. Start giving Vitamin K to every newborn (1 mg to full term and 0.5 mg to pre-term neonates).

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29. PHC Chappar

i. NBCC is not established till the day of visit.

ii. No thermal care is provided to the newborn to prevent hypothermia.

iii. Suction machine is available but not functional.

iv. Oxygen cylinder available at the facility was found empty.

v. Baby sheets are not available at the facility.

vi. Phototherapy machine is available but lying unused.

vii. Medicines like Mg sulf, Misoprost, and Vitamin K is not in supply.


i. Milking of cord and immediate cord cutting is in the practice.

ii. Skin to skin contact is not practiced and every newborn is shifted to the radiant warmer.

iii. Suction is done for every newborn irrespective of the need.

Recommendations:

i. Establish NBCC and make it operational as soon as possible.

ii. Ensure the availability of baby sheets, Oxygen cylinder and medicines (Mg Sulf, Mesoprost

and Vitamin K) in the facility.

iii. Make suction machine operational and ensure the availability of mucous extractor until then.

iv. Move the available unused equipments like Phototherapy; to the site where it is needed.

v. Oxytocin should be administered as AMTSL, not for augmentation.

vi. 6 step hand wash is to be done as readiness before delivery.

vii. Double gloving is advised as mandatory requirement for infection prevention.

viii. Discourage milking of cord and suction for every newborn.

ix. Make it a practice/advocate to cut cord between 1 to 3 minutes of birth with disposable


x. Skin to skin contact is best for thermal care of baby; it has to be provided to each and every


xi. Start giving Vitamin K to every newborn (1 mg to full term and 0.5 mg to pre-term neonates).

30. PHC DHANI JAMALPUR

• Zero number mask is not available.


i. Milking of the cord and immediate cord cutting is in practice.

ii. Suctioning of every newborn is in practice.

iii. Shifting all babies to the NBCC immediately after birth.


v. Skills related to resuscitation are not in chronological order.

vi. Infection prevention practices are not followed.

vii. Phototherapy unit is lying unused.

Recommendations:

i. Infection prevention practices should be followed strictly according to the protocols.

ii. Ensure the availability of zero size mask at the NBCC.

iii. Phototherapy unit should be moved to the site where it is needed.

36










31. PHC Dhani Mahu

i. Cradle is available in post natal ward of the facility.

ii. Mask of zero number is not available.

iii. Mucus extractor is not available.

iv. Hand washing is not done properly.


i. There is practice of hanging child in head downward position.

ii. Milking of the cord and immediate cord cutting is in practice.

iii. There is practice of suction to every newborn.

iv. Transferring every newborn to NBCC is in practice.

v. Skin-to-skin contact is not practiced.

vi. Resuscitation skills were poor.

Recommendations:

i. Ensure the availability of zero size Mask and Mucous extractor at the NBCC.

ii. Cradle should be removed from the post natal ward.

iii. Ensure Hand washing with 6 steps method as it is a set protocol for infection prevention.










32. PHC DHIGAWA

i. There is good delivery load of 15-20/month.

ii. Mucous extractor is not available at the NBCC.

iii. Doppler is non-functional.

iv. Baby cloth is not available at the facility.

v. Inj. Mg sulf and Tab. Misoprost is not available at the facility.

vi. Expired Intravenous fluids and drugs were found at the time of the visit.

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i. Immunization is not done for the newborn taking birth in the facility.

ii. Milking of cord and immediate cord cutting is in practice.

iii. Suctioning of every newborn is in practice.


v. Skills related to resuscitation are not in chronological order.

vi. Infection prevention practices are not followed.

Recommendations:

i. Ensure the implementation of early expiry first out mechanism to prevent stock of drug

expiry.

ii. Ensure availability of Baby cloth and Mucous extractor in the facility.

iii. Ensure the functionality of the Doppler.

iv. Ensure the uninterrupted supply of Inj.Mg Sulf and Tab. Misoprost.

v. Oxytocin should be administered as AMTSL, not for augmentation.

vi. 6 step hand wash is to be done as readiness before delivery.

vii. Double gloving is advised as mandatory requirement for infection prevention.

viii. Discourage milking of cord and suction for every newborn.

ix. Make it a practice/advocate to cut cord between 1 to 3 minutes of birth with disposable


x. Skin to skin contact is best for thermal care of baby; it has to be provided to each and every


xi. Start giving Vitamin K to every newborn (1 mg to full term and 0.5 mg to pre-term neonates).

33. PHC DINOD

• Immunization of newborn with BCG, Hep B and OPV done after every delivery


i. Immediate cord cutting in practice with milking of the cord.

ii. Skin to skin contact is not practiced.

iii. Every new born is being taken to NBCC despite of their condition.

iv. Knowledge of staff nurses about resuscitation is fairly good.

v. IEC material for essential newborn care is not available.

Recommendations:










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34. PHC Kharak Kalan

i. Good display of IEC materials.

ii. Wall clock is available but not functional.

iii. Only Hepatitis B and OPV is given at birth.

iv. Vitamin k is not available at the facility.

v. Phototherapy unit is available but lying unutilized.


i. Immediate cord cutting and milking of cord is in practice.

ii. Suctioning of every newborn is in practice.

iii. Shifting all babies to the NBCC immediately after birth.


v. Skills related to resuscitation not in chronological order.

vi. Infection prevention practices are not followed according to protocols.

Recommendations:

i. Double gloving is advised as mandatory requirement for infection prevention.

ii. Phototherapy unit should be moved ASAP wherever it can be utilized.







35. PHC Maikalan

• Newborn corner register not available at the facility.

• 3 Staff nurses recruited at the facility are not skilled about the use of bag and mask.


i. Immediate cord cutting was a usual practice.

ii. Skin to skin contact is not in practice.

iii. Administration of Vitamin K is not in practice.

iv. Chronology of essential new born care & resuscitation not clear to the staff.

v. Staff nurses not aware about disinfection.

Recommendations:








vi. 3 Staff nurses recruited need to be trained for NSSK.

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36. PHC Manakawas

• The delivery instruments are found in rusted condition.

• Crib and phototherapy unit is available at the facility.


i. Double gloving not in practice.

ii. Chronology of essential new born care & resuscitation is not clear to the staff.

iii. Immediate cord cutting after milking of the cord.

iv. Suction is done of every newborn even with normal vitals.

v. Shifting all baby to the NBCC immediately after birth irrespective of newborn’s condition.

vi. Skin to skin contact is not practiced.

Recommendations:








37. PHC Pur

• Hand washing before conducting delivery is not done according to protocols.


i. Oxytocin administration during labour for augmentation is in practice.

ii. Immediate cord cutting is in practice.

iii. Transferring every child to the new born care corner after delivery for suction is in practice.

iv. Skin-to-skin contact is not practiced between mother and child.

v. Resuscitation skills were average.


Recommendations:










38. PHC Ranila

i. Bag & Mask found dirty and O no. mask is not available.

ii. Roster is not followed properly.

iii. Partograph is not filled correctly.

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iv. Vitamin k is not available at the facility.

v. Infection prevention protocols not in practice as instruments are not autoclaved.

vi. Radiant warmer is not used during the summer season.


i. Oxytocin administration during labour is in practice.

ii. Hand washing before conducting delivery is not done according to protocols.

iii. Milking of cord is done before cutting the cord immediately after the delivery.

iv. Transferring every child to the new born care corner after delivery for suction is in practice.


vi. Chronology of essential new born care & resuscitation is missing.

vii. Resuscitation skills are found average.

Recommendations:










39. PHC Santokpura:

• Birth preparedness at the facility is nonexistent before any delivery.

• Staff nurses are well trained but lack skills in practice.

• No Documentation on essential new born care in case records.

• IEC material for essential new born care not available.

• Weighing machine at the facility is non functional.

• Disinfection of equipments is not according to the protocols.


i. Skin to skin contact is not practiced between the mother and child after delivery.

ii. Immediate cord cut & milking of cord in practice.

iii. Suction is done for every new born at the facility.

iv. Administration of Vitamin K to the new born is not in practice.

v. Staff nurse lacks in chronological steps of resuscitation.

Recommendations:









41


40. PHC Sanwar

• Good practice of giving birth dose of BCG, Hep B, OPV.

• Essential new born care is not documented in case records.

• IEC material for essential new born care is not available at the facility.

• Sheet to be used as Baby cloth found dirty at the time of visit.


i. Skin to skin contact is not practiced to keep new born warm.



iv. Vitamin K is available in the facility but not administered to new born.

v. Staff nurses are well trained but lack skills for resuscitation.

Recommendations:

i. 6 step hand wash is to be done as readiness before delivery.

ii. Double gloving is advised as mandatory requirement for infection prevention.







41. PHC Sohansada

• Baby sheets not available at facility for drying and wrapping of newborn.

• Oxygen cylinder not in functional condition.

• Open Wiring at NBCC, which is against the protocols.

• Medicines required refrigeration are placed at room temperature.

• 4 Staff Nurses posted at facility required trainings like IMNCI, SBA etc.

• Autoclave machine is out of order, hence affecting the infection prevention protocols.

• Weighting machine at nursing station is out of order.







Recommendations:






42




42. PHC Talu

i. Light is inadequate inside the labour room and NBCC.

ii. Zero and one number mask is not available with bag.

iii. Baby sheets are not available for drying and wrapping.

iv. Suction machine is out of order.

v. 3 Staff Nurse appointed at facility but not trained in NSSK & IMNCI.







Recommendations:









43. PHC Nakipur


i. Immediate Cord cutting is in practice.

ii. Taking every newborn to warmer after cutting the cord.

iii. Suctioning of every newborn is done even with normal vitals.


v. Skills for neonatal resuscitation are lacking.

vi. Chronology of Resuscitation steps not present

Recommendations:









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44. PHC Biran

• Radiant Warmer is not working properly.



ii. Suctioning of every newborn is done despite the normal vitals.

iii. Taking every newborn to warmer is in practice.

iv. Skin to skin contact is not practiced between mother and child.


vi. Chronology of Resuscitation steps is not present.

Recommendations:

i. Radiant warmer need urgent repair.









45. PHC Achina








Recommendations:

i. Radiant warmer need urgent repair.









46. PHC Sandhwa

• It is not a 24x7 facility.

• The facility is running in a sub centre building with 3 rooms.

• Only Staff posted in the facility is nurse.

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• No records were available at the time of visit.








Recommendations:









47. SC Chiriya

• D.L. mucous extractor not available in sufficient quantity.

• Craddle is present in labour room.

• Newborn care corner is not established till the day of visit.

• The case records are not being filled.



ii. Skin to skin contact is not practiced between mother and child.

iii. Chronology of essential new born care is not clear to the staff.

iv. Staff available in the facility lack in proper resuscitation skills.

v. Baby after birth is kept in phototherapy machine.

vi. Double gloving is not in practice.

vii. Infection prevention protocols not being followed.

48. SC Dangkalan

• Newborn care corner is not established till the day of visit.

• Self inflating bag is not available at the sub centre.

• Cord clamps are not available in sufficient quantity.

• The case history taking sheets are not available.



ii. Skin to skin contact is not practiced and baby is kept in phototherapy machine.

iii. Chronology of essential new born care is not clear to the staff.

iv. Staff lacks proper resuscitation skills in chronology.

v. Double gloving is not in practice.

vi. Infection prevention protocols not being followed.

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49. SC Mandhana

• Newborn care corner is not established.

• One number mask not available with bag.

• Phototherapy machine is installed at Sub centre.

• Emergency medicines i.e. Mg Sulph, Misoprost, Oxytocin and Methargin are out of stock.


i. Separation of healthy newborn and mother is usual practice.

ii. Milking and immediate cord cutting is in usual practice.

iii. Skin to skin contact is not practiced and baby is kept in phototherapy machine.

iv. Chronology of essential new born care is not clear to the staff.

v. Staff lacks proper resuscitation skills in chronology.

vi. Double gloving is not in practice.

50. SC Durjanpur

i. Sub center has a clean and well maintained labour room.

ii. Sub centre has an average delivery load of 30 per month.

iii. New born care corner is not established.

iv. Hand washing corner unavailable in the labour room.

v. ANMs posted in the sub centre are not trained in SBA, NSSK.

vi. Mucous Extractor & Foot/Automatic Suction machine lying unutilized.

vii. Case sheets/ Partographs are not available.

viii. Duration of pregnancy not mentioned in Delivery register.

ix. Oxygen cylinder available at the facility is found empty.


i. Clean & new blade is used for cord cutting.

ii. Feeding tube is attached to a 10ml syringe in use for suction. Separation of healthy newborn

and mother is usual practice.

iii. Milking and immediate cord cutting is in practice.

iv. Skin to skin contact is not practiced and baby is kept in phototherapy machine.

v. Chronology of essential new born care is not clear to the staff.

vi. Staff lacks proper resuscitation skills in chronology.

vii. Double gloving is not in practice.

General Recommendations for Sub-Centres/Delivery Huts:

i. Phototherapy units available in the sub centres should be moved to the SU’s and SNCU’s.

ii. Follow infection prevention protocols in strict accordance. Advocate and monitor effective

hand washing (6 golden steps for 2 minutes) in the birth attendants.

iii. Advocate infection prevention and hygiene by using standard protocols.





vi. Discourage milking of cord and suction for every newborn.

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vii. Record keeping should be improved. Advocate filling of each and every detail about the

services given to mother and newborn in the case sheets.

viii. All the medication in any form i.e. tablets, injectables; given to mother or child should be

mention with dosage administered, time of administration.

rapid 24 june 6 july, 2013 assessment district bhiwani · 24 june – 6 july, 2013 district bhiwani...

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