QI Reduces Cases of Sepsis at Ntchisi District Hospital
By Maria T
Ntchisi district hospital has registered a decrease in number of neonatal deaths due to neonatal sepsis over the period. All this due to Quality Improvement mentors who lobbied with Management, for a separate unit for neonates both premature and sick to be isolated from others. QI mentors having been trained in QI by Maikhanda with support from Comic Relief were made to understand their system and processes. Through a process mapping exercise and looking at their data realized most of the districts’ neonatal sepsis cases, were due to congestion in postnatal ward. It is through this that management was lobbied for a demarcation of a bay to have a KMC. A demarcation using plywood was done but there was no nurse allocated and sick babies were also combined with premature babies which had put premature babies at risk of infection. Management was involved further, on how mixing of babies was putting others at risk, with no nurse allocated relying on postnatal nurses babies were still dying. Later, KMC was moved to maternity with proper demarcation of nursery and KMC but relying on nurses and clinicians from maternity ward to be doing ward rounds and monitoring.
Sometimes a day could pass without nurse or clinician to check on the babies due to workload in maternity. The case was still presented to management as KMC mothers could not see the reason of being at the facility when their babies could not be checked. Number of absconders also increased. Together with Save the children, Maikhanda and the qi mentors management was challenged to set up a stand-alone unit for neonates where nurses and clinicians are located and that as management will be making its decisions it will be able to consider needs of the unit.
From July 2016 a new Neonatal unit was established at Ntchisi District hospital where 4 nurses and 2 clinicians were allocated. From July 2016 to March 2017, there were only 2 Neonatal deaths with highest instance in November but all were managed properly. However, six months prior to proper neonatal unit, there were 6 neonatal deaths due to sepsis and adherence to sepsis protocol was very poor.
Before the project sepsis cases could go as high as 21 with 2or 1 NND a month. The process of demarcation and moving of KMC started in September 2015.
MaiKhanda Trust is a Malawian non-governmental and nonprofit organization established and registered under Trustees Incorporation Act in 2006. MaiKhanda works with the Ministry of Health and all partners and stakeholders in Maternal and Neonatal Health service delivery.
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