Laqshya UPSC

Labour Room Quality Improvement Initiative 2017 (National Health Mission, Ministry of Health and Family Welfare GOI)

OBJECTIVES

1. To reduce maternal and newborn mortality & morbidity due to APH, PPH, retained placenta, preterm, preeclampsia & eclampsia, obstructed labour, puerperal sepsis, newborn asphyxia, and sepsis, etc.
2. To improve Quality of care during the delivery and immediate post-partum care, stabilization of complications and ensure timely referrals, and enable an effective two-way follow-up system.
3. To enhance satisfaction of beneficiaries visiting the health facilities and provide Respectful Maternity Care (RMC) to all pregnant women attending the public health facility.

STRATEGIES

1. Reorganizing/aligning Labour room & Maternity Operation Theatre layout and workflow as per ‘Labour Room Standardization Guidelines’ and ‘Maternal & Newborn Health Toolkit’ issued by the Ministry of Health & Family Welfare, Government of India.
2. Ensuring that at least all government medical college hospitals and high case-load district hospitals have dedicated obstetric HDUs as per GoI MOHFW Guidelines, for managing complicated pregnancies that require life-saving critical care.
3. Ensuring strict adherence to clinical protocols for management and stabilization of the complications before referral to higher centres.

SCOPE

Following facilities would be taken under LaQshya initiative on priority:

• All government medical college hospitals.
• All District Hospitals & equivalent health facilities.
• All designated FRUs and high case load CHCs with over 100 deliveries/60 (per month) in hills and desert areas.

TARGETS

Immediate

1. 80% of the selected Labour rooms & Maternity OTs assess their quality and staff competence using defined NQAS checklists and OSCE.
2. 80% of Labour rooms & Maternity OTs have setup functional quality circles and facility level quality teams

Short Term (up to 8 Months)

1. 80% of Labour Room and OT Quality Circles are oriented to latest labour room protocols, quality improvement processes and respectful maternity care (RMC).
2. 50% of deliveries take place in presence of the Birth Companions.
3. 60% of deliveries conducted using safe birth checklist and Safe Surgery Checklist in Labour Room & Maternity OT respectively.
4. 60% of the deliveries are conducted using real-time partograph.
5. 30% increase in Breast Feeding within one hour of delivery.
6. 80% labour rooms and Maternity OTs take microbiological samples from defined areas every month.
7. 30% reduction in surgical site infection rate in the Maternity OT.

Intermediate-Term (Up to 12 months)

1. 30% increase in antenatal corticosteroid administration in case of preterm labour.
2. 30% reduction in pre-eclampsia, eclampsia & PIH related mortality.
3. 30% reduction in APH/PPH related mortality.
4. 20% reduction in new-born asphyxia related admissions in SNCUs for inborn deliveries.
5. 20% reduction in newborn sepsis rate in SNCUs for inborn deliveries.
6. 20% reduction in Stillbirth rate.
7. 80% of all beneficiaries are either satisfied or highly satisfied.
8. 60% of the labour rooms are reorganized as per ‘Guidelines for Standardisation of Labour Rooms at Delivery Points’.
9. 80% of labour rooms have staffing as per defined norms.
10. 100% compliance to administration of Oxytocin, immediately after birth.
11. 30% improvement in OSCE scores of labour room staff.
12. 100% Maternal death, Neonatal Death audit and clinical discussion on near miss/maternal and neonatal complications.
13. 80% Labour Room and OTs are reporting zero stock-outs of drugs and consumables.

Long Term (up to 18 months)

1. 60% of labour rooms achieve quality certification against the NQAS.
2. 50% of labour rooms are linked to Obstetrics HDU/ICU.
3. 15% improvement in short term & Intermediate targets.

CERTIFICATIONS, INCENTIVES & BRANDING

• Quality Improvement in labour room and maternity OT will be assessed through NQAS (National Quality Assurance Standards). Every facility achieving 70% score on NQAS will be certified as LaQshya certified facility.
• Furthermore, branding of LaQshya certified facilities will be done as per the NQAS score. Facilities scoring more than 90%, 80% and 70% will be given Platinum, Gold and Silver badge accordingly.
• Facilities achieving NQAS certification, defined quality indicators and 80% satisfied beneficiaries will be provided incentive of Rs. 6 lakhs, Rs.3 lakhs and Rs.2 lakhs for Medical College Hospital, District Hospital and FRUs respectively.