Magna Scientia Advanced Biology And Pharmacy

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Magna Scientia Advanced Biology and Pharmacy, 2020, 01(01), 025–035Magna Scientia Advanced Biology and PharmacyCross Ref DOI: 10.30574/msabpJournal homepage: E S E A R C H A R T I C L E )Continuous improvement of the quality of neonatal care based on “SupportiveSupervision” principleSaadat Huseynova *Scientific Research Institute of Obstetrics and Gynecology, Baku, Azerbaijan.Publication history: Received on 20 September 2020; revised on 15 November 2020; accepted on 22 November 2020Article DOI: ctMaternal mortality and morbidity depend on many factors, including the quality of birth care and neonatal care services.Quality indicators should be there to measure the quality of any service.The project aims to test and implement supportive supervision principles at the ten maternity hospitals (within the cityof Baku). Helping to Identify and to solve current problems in the quality of medical services, as well as guiding theMinistry of Healthcare to implement supportive supervision in the healthcare system, are also primary goals.It focuses on deficiencies, errors, and audits individuals, not the process. As a result of supportive supervision, the staffparticipates in problem-solving, perceives a supervisor better, does not hesitate to identify problems, and actively getsinvolved in solving them.The result of the research shows that supportive supervision has a positive impact on improving the quality of services.Supportive supervision should be applied regularly, not on seasonal occasions. External, as well as internal audits,require the supportive supervision initiative. The results of such inspections should be available to a broader audienceto create a competitive environment among institutions. Supportive supervision also helps to identify both biased andobjective (non-facility related) factors that negatively affect the quality of services. Discussing objective factors at anintersectoral level, and finding solutions to problems is necessary to improve the quality of services.Keywords: Perinatal; Neonatal; Intensive Care; Supportive Supervision; Maternal Hospital; Clinical Researches1. IntroductionMother and child health is at the core of the public health system’s focus. Maternal mortality and morbidity depend onmany factors, including the quality of birth care and neonatal care services [1-4]. Quality indicators should be there tomeasure the quality of any service. An appropriate monitoring and evaluation system is essential to improve theseindicators or to keep their condition at best. In recent years, the supportive supervision approach to improving medicalservices has been successfully applied in various parts of the world [1, 3, 4, 5]. Under the ACQUIRE project, the COPEapproach (by Engender Health) is adopted to implement the supportive supervision at the selected medical facilities ofa few districts in Azerbaijan.The Ministry of Healthcare decided to test the supportive supervisory approach at the ten facilities in Baku. Integratingthe current quality assurance system of medical services to the supportive supervisory principles would improve thequality of services related to birth care neonatal care services.The Public Health and Reforms Center was appointed to run the project with the technical support of the State Instituteof Obstetrics and Gynecology (IOG) and with the financial support of UNICEF. The project aims to test and implement Corresponding author: Saadat HuseynovaScientific Research Institute of Obstetrics and Gynecology, Baku, Azerbaijan.Copyright 2020 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0.

Magna Scientia Advanced Biology and Pharmacy, 2020, 01(01), 025–035supportive supervision principles at the ten maternity hospitals (within the city of Baku). Helping to Identify and tosolve current problems in the quality of medical services, as well as guiding the Ministry of Healthcare to implementsupportive supervision in the healthcare system, are also primary goals.Supportive supervision reflects the attitude and position. It is also a process that encourages employees to improvetheir professionalism, to work better, and to provide quality services. Audit control is usually shallow and punitive. Itfocuses on deficiencies, errors, and audits individuals, not the process. Thus, it is based on the past instead of the future.In comparison, supportive supervision concentrates on solving problems of staff by pushing and supporting the qualityimprovement process. It focuses on the process rather than individuals.As a result of supportive supervision, the staff participates in problem-solving, perceives a supervisor better, does nothesitate to identify problems, and actively gets involved in solving them. Employees are given opportunities to realizetheir potential.2. MethodsThree working groups have been formed to work with institutions. Each group includes 1 Public Health and ReformCenter (PHRC) and 2 Republic Maternity and Gynecology Institute (RMGI) (gynecologist and neonatologist)representatives. A 2-day training was organized for the working groups. Tools to implement the project were identifiedthroughout the training program. A 1-day training program was conducted among managers and representatives ofselected institutions to explain goals, objectives, and approaches of the project. Table 1 shows the list of medicalinstitutions involved in the research and the number of staff (according to each institution) who participated in thetraining program.Table 1 Number of employees trained within the 12 months prior to the start of the projectName of InstitutionRepublican Perinatal CenterClinical Medical CenterMaternity Hospital N2Maternity Hospital N3Maternity Hospital N5Republican Clinical HospitalUnited City Hospital N6United City Hospital N26Maternity Hospital N7Number of employees trained inthe last 12 months2255846622821266Factors that determine the quality of neonatal service are grouped under sections mentioned below:The initial intensive care for newborn childMaternal care for healthy newbornSustaining required thermal conditionsInfection controlFeeding an ill newbornMaternal care and treatment for an ill newbornVisiting institutions started by meeting with managers. Managers were informed about the project and its workingalgorithm. In return, they briefed general information regarding their institutions. Coordinator and members ofContinuous Improvement in the Quality of Services (CIQS) groups were identified according to the recommendation ofmanagers. The groups were also informed about the project and its working algorithm.Following approaches are used to determine the quality of services:Talking to employeesObservationsReviewing medical documentations26

Magna Scientia Advanced Biology and Pharmacy, 2020, 01(01), 025–035Data obtained through employee interviews, observations, and review of medical records is reported in unique forms.These forms reflect the quality of services that are based on WHO recommendations. The fill-out form consists of severalsections, and each one presents several parameters for evaluation.Values range from 0 to 3:0 - It isn’t implemented at all1 - Significant improvement needed2 - Little improvement3 - Fully implementedThe average value in the specific form is noted.The result of the evaluation is discussed with CIQS to identify current problems and their reasons. Two-three solutions,responsible employees, and deadlines are determined and recorded in the form of an action plan. CIQS has a copy of allthe documents.2.1. StatisticsThe difference regarding quantitative indicators among groups was determined by the Mann Whitney U and Student ttest, and differentiating the presence frequency of quality parameters among groups is identified by the Pearson X2 test.In all cases, if the difference among compared groups is p 0.05, then the result is considered to be statistically accurate.3. ResultsThe main parameters that reflect the quality of neonatal care and the evaluation results of these parameters in theparticipating medical facilities vary from one to another. The initial evaluation values of facilities regarding the initialprenatal resuscitation are 0.8 and 2.4, and the last evaluation values are between 1.0 and 3.0 in Tables 2 and 3.Table 2 Parameters of initial intensive care for neonatal newbornParametersNever beenappliedSignificantimprovement requiredCumulative(%)The location of Intensive Care099 (9.7)Availability and working condition of theheater9918 (19.4)Availability of visual data in the maternityroom01313 (14.0)Oxygen delivery to the intensive care unit171330 (32.3)Availability and working condition of toolsfor auxiliary ventilation41620 (21.5)Availability, placement and storage ofother intensive care facilities22628 (30.1)Medicine required for intensive care6410 (10.8)Regularly inspection of intensive caretools72835 (37.6)Organizing the initial intensive care forthe newborn at the maternity room63743 (46.2)Availability and fill out of documentsrequired for the initial intensive care311041 (44.1)Initial Intensive Care Training242953 (57.0)27

Magna Scientia Advanced Biology and Pharmacy, 2020, 01(01), 025–035Clinical Medical Center (CMC) and Republican Perinatal Center (RPC) N 2,5,6,7 achieved significant improvement in theresults. As seen from Table 2, it is obvious to feel the great need of improving the results for Baku City Hospital (BCH)N26, Republican Clinical Hospital (RCH), and Maternity Hospital (MH) N3. After reviewing results, organizing initialresuscitation for newborns and the training for the staff need to be advanced. Filling out medical papers is crucial inpursuing clinical research, analyzing & resolving errors, and developing the project. At the same time, in some cases,these documents would become helpful in protecting healthcare workers.Table 3 Initial intensive care for a newbornInstitutionInitial valueFinal valueMaternity Hospital N11.21.8Maternity Hospital N21.62.3United City Hospital N261.01.3Maternity Hospital N30.81.0Maternity Hospital N51.53.0United City Hospital N60.82.4Maternity Hospital N71.82.8Clinical Medical Center1.82.6Republican Clinical Hospital1.21.8Republican Perinatal Center2.42.7Initial values of results in healthy newborns are 0.9 and 2.3, and final values range between 1.7 and 3.0 (Table 4, Table5). The dramatic improvement in this parameter was achieved by Maternity Hospitals N5, 6, 7. The main issues in thissection are skin contact, early breast implantation, prevention of neonatal hemorrhagic disease, and training of mothers.Table 4 Parameters of maternal care for healthy newbornsParametersNeverappliedRoutine absorption of mucus atbirthSignificant improvementrequiredCumulative (%)167 (7.5)Skin to skin contact34043 (46.2)Early initiation of breastfeeding72835 (37.6)Prevention of blennorrhea4711 (11.8)Cleaning and caring belly button279 (9.7)Initial medical check-up and theassessmentofphysicaldevelopment41822 (23.7)Keeping Mother andtogether after delivery81523 (24.7)Prevention of hemorrhagicdisease among newborn183149 (52.7)Vaccination of newborns022 (2.2)Training for mothers233457 (61.3)babybeen28

Magna Scientia Advanced Biology and Pharmacy, 2020, 01(01), 025–035Table 5 Maternal Care for a healthy newbornInstitutionInitial valueFinal valueMaternity Hospital N11.61.7Maternity Hospital N22.12.3United City Hospital N262.32.5Maternity Hospital N30.91.9Maternity Hospital N51.83.0United City Hospital N61.52.5Maternity Hospital N71.72.7Clinical Medical Center2.02.4Republican Clinical Hospital1.32.0Republican Perinatal Center2.22.5As indicated in Tables 6 and 7, the initial evaluation results of the factors contributing to the thermal condition for theinstitutions are 0.1 and 2.4, and the final values are between 1.8 and 3.0. MH, CMC, RCH, RPC N1,5,6,7 were able toadvance this department significantly. Additionally, there is a strong need for improvement in this index for MH N2 &3 and BCH N26. Observing the thermal condition during the transfer of the infant and warming the child in hypothermiaare primary issues in this section.Table 6 Parameters to sustain required thermal conditionParametersNeverappliedSustaining required thermalcondition at maternity roomsSignificantimprovement requiredCumulative (%)246 (6.5)Sustaining required thermalcondition at maternal andintensive therapy wards4610 (10.8)Examining body temperature ofa newborn in the first 30minutes at the maternity roomand after 2 hours61925 (26.9)Examining body temperature ofa newborn everyday31316 (17.2)Sustainingrequiredtemperature while relocatingnewborns53439 (41.9)Free pattern for baby swaddlingwrap72128 (30.1)Warminghypothermia83038 (40.9)babywithbeen29

Magna Scientia Advanced Biology and Pharmacy, 2020, 01(01), 025–035Table 7 Compliance with the required thermal conditionInstitutionInitial valueFinal valueMaternity Hospital N11.42.3Maternity Hospital N22.31.8United City Hospital N262.42.0Maternity Hospital N30.12.0Maternity Hospital N51.63.0United City Hospital N60.82.7Maternity Hospital N71.83.0Clinical Medical Center1.72.6Republican Clinical Hospital1.32.3Republican Perinatal Center1.82.7Values regarding the results that control the infection are 0.5 and 2.2, and the final values range between 1.0 and 2.9(Table 8 & 9). Maternal Hospital N5 & 7 achieved a significant upgrade in this index. Specifically, Maternal Hospital N3,BCH N 6, and RCH have weak infection control. Although BCH N 26, CMC, and RPM have achieved significantimprovement, they should try to improve it even more. Most of the parameters in this section seem to requireconsiderable progress. There is an urgent need to enhance hand-washing habits and infection control experience inaddition to equipment-related issues.Table 8 Infection control ement requiredCumulative (%)Availabilityandworkingcondition of washing bowls01313 (14.0)Liquid soap21315 (16.1)Hand sanitizer92433 (35.5)Disposable towels53237 (39.8)Hand washing habits145 (5.4)Availability of disposable items34447 (50.5)Storage and usage of intensivecare tools23436 (38.7)Storage and usagemedical equipmentsother22830 (32.3)Newborn and mother visitationsby relatives95059 (63.4)Hospital infectionregistration81826 (28.0)25254 (58.1)ofandInfection control practiceits30

Magna Scientia Advanced Biology and Pharmacy, 2020, 01(01), 025–035Table 9 Infection controlInstitutionInitial valueFinal valueMaternity Hospital N10.91.4Maternity Hospital N22.21.7United City Hospital N261.62.2Maternity Hospital N30.51.0Maternity Hospital N51.42.9United City Hospital N60.81.7Maternity Hospital N71.32.6Clinical Medical Center1.72.2Republican Clinical Hospital1.21.3Republican Perinatal Center2.12.4The initial values of the results that define the ill newborn’s feeding are 0.5 and 2.2, and the final values are between 1.0and 3.0 (Table 10 & 11). MH and RPC N5 and 7 have serious progress under this parameter. Other facilities need todevelop this index considerably. Although breastfeeding does not require substantial improvement, there are manyproblems related to it. In most cases, exclusive breastfeeding is disrupted, and breastfeeding in the initial phase isdelayed. Lack of equipment, staff’s knowledge, and capabilities are principal problems of parenteral feeding.Table 10 Parameters of feeding for a newborn with illnessParametersNever been appliedSignificantimprovementrequiredCumulative (%)01313 (14.0)Alternative nutrition03131 (33.3)The practice of feedingpremature infants93746 (49.5)Theexperienceofparenteral nutrition of a illinfant372259 (63.4)The experience of enteralnutrition for a ill infant92736 (38.7)Availability of parenteralpreparations and tools forparenteral nutrition213758 (62.4)Defining and registeringbaby’s nutritional status282351 (54.8)Determiningglycemia292958 (62.4)Breastfeedingbreast milkandusingneonatal31

Magna Scientia Advanced Biology and Pharmacy, 2020, 01(01), 025–035Table 11 Feeding a newborn infant with illnessInstitutionInitial valueFinal valueMaternity Hospital N11.11.4Maternity Hospital N21.91.9United City Hospital N261.91.6Maternity Hospital N30.51.0Maternity Hospital N51.53.0United City Hospital N61.02.0Maternity Hospital N71.42.5Clinical Medical Center1.02.0Republican Clinical Hospital1.01.2Republican Perinatal Center2.22.6In Table 12 &13, initial values of care and treatment for an ill newborn are between 0.3 and 2.0, and the final values arebetween 0.8 and 2.6. MH and RPC N5 & 7 have achieved essential advancements in this department. Other facilitiesrequire significant improvement regarding this indicator. Most of the factors that shape this unit urge considerabledevelopment as well. Staff seriously needs to be trained for the basics of care to newborns. In addition to the treatmentof brain injury, the use of blood components, antibacterial therapy, and adequate medication use should be enhanced.There is a need to increase the capabilities of observation and laboratory-instrumental examination of an ill child.Table 12 Maternal care and treatment for newborn babies with ement requiredCumulative (%)Prevention of infection in newborns232245 (48.4)Nursing care for an ill newborn84755 (59.1)Observing the sick child363874 (79.6)Instrumentalandlaboratoryobservation capabilities135568 (73.1)Proper use of medicines143650 (53.8)Respiratory therapy272350 (53.8)Antibacterial therapy164561 (65.6)Relieving pain of a newborn233457 (61.3)Treatment for brain injury164157 (61.3)Treatment of jaundice in newborns163046 (49.5)Using blood and its components433578 (83.9)Transferring newborns from onemedical facility to other one43346 (49.5)Teaching basics of maternal care fornewborns to staff332760 (64.5)32

Magna Scientia Advanced Biology and Pharmacy, 2020, 01(01), 025–035Table 13 Maternal care and treatment for newborn babies with illnessInstitutionInitial valueFinal valueMaternity Hospital N11.01.2Maternity Hospital N21.81.7United City Hospital N261.21.5Maternity Hospital N30.30.8Maternity Hospital N51.22.6Maternity Hospital N71.22.3Clinical Medical Center1.32.0Republican Clinical Hospital2.01.2Republican Perinatal Center1.92.6United City Hospital N64. DiscussionExecuting continuous development of supportive supervision and neonatal care projects for 11 months proves thatselected tools to identify problems and solutions are useful. During the supportive supervision project: The staff is onlyresponsible for identifying problems. Members of the team from various levels participate in researching the quality ofservices and solving problems. A variety of sources enables us to obtain accurate information. The multi-parameterservice quality indicators have been presented. Obligations for the team, their deadline, and designated people havebeen identified. In most cases, service quality has been improved.At the same time, there are objective and subjective difficulties in troubleshooting as well: Managers and staff lacksufficient knowledge regarding the quality indicators. Transferring modern knowledge and skills within the institutionis also weak. In most cases, employees don’t approach certain factors in a standard way. Personal stereotypes have anenormous impact. It is hard to resolve the issues related to stereotypes. To overcome such problems, we need acontinuous internal and external audit as well as repetitive training for staff. In other cases, managers' instructionseither detract employees from providing modernized services or don't encourage staff to provide such services. In manycases, clinical protocols, requirements of proven medicine and the orders of the Healthcare Ministry are not followed indaily practices. Often, employee duties aren't clear. Managers do not regularly evaluate their work. Employee incentives

Magna Scientia Advanced Biology and Pharmacy, 2020, 01(01), 025–035 27 Data obtained through employee interviews, observations, and review of medical records is reported in unique forms. These forms reflect the quality of services that are based on WHO recommendations. The fill-out form consists of several

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