Publications by authors named "Meena Joshi"

7 Publications

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Quality improvement initiative for reduction of false alarms from multiparameter monitors in neonatal intensive care unit.

J Educ Health Promot 2019 24;8:203. Epub 2019 Oct 24.

Department of Pediatrics, Division of Neonatology, All India Institute of Medical Sciences, New Delhi, India.

Introduction: Unnecessary and excessive activation of alarms ("false alarm") in neonatal intensive care unit (NICU) often results in alarm fatigue among health-care professionals, which can potentially result in deleterious effects in sick neonates.

Aims And Objectives: The aim of this study is to reduce the frequency of false alarms from multiparameter monitors (MPM) by 50% from the existing baseline level over a period of 12 weeks.

Methods: In this quality improvement (QI) project conducted over 1 year (November 2016-October 2017) at All India Institute of Medical Sciences, New Delhi, we collected data on activation of false alarms from MPM (outcome measure) over a period of 2 months in 134 randomly selected observations of 1-h duration (baseline phase [10 days, 20 observations] and developing and testing the changes in five Plan-Do-study-Act (PDSA) cycles over the next 50 days, 114 observations. We also measured the pre- and postassessment of knowledge level in use of MPM among health-care professionals using checklist (process measure). Following that, we continued data collection for next 10 months to check sustenance of the project.

Results: Baseline characteristics including gestation, birth weight, and sickness level did not vary during the study period. The median (range) number of activation of false alarms/hour/MPM was 23 (18-35) in the baseline phase. This reduced to 22 (17-30), 19 (15-30), 16 (14-30), 14 (8-17), and 9 (6-12) at the end of 1, 2, 3, 4, and 5 PDSA cycles, respectively. In sustenance phase, it could be maintained in target range from January 2017 to October 2017.

Conclusions: Small sustained changes can contribute a lot in continuous QI in decreasing false alarms and subsequent improvement of neurodevelopmental outcomes discharged neonates.
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http://dx.doi.org/10.4103/jehp.jehp_226_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6852305PMC
October 2019

Gains from Quality Improvement Initiatives - Experience from a Tertiary-care Institute in India.

Indian Pediatr 2018 Sep;55(9):809-817

Division of Neonatology, Newborn Health Knowledge Centre (NHKC), WHO Collaborating Center of Training and Research, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. Correspondence to: Dr Ramesh Agarwal, Professor, Department of Pediatrics, WHO Collaborating Centre for Education and Research in Newborn Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.

Quality improvement (QI) in healthcare involves implementing small iterative changes by a team of people using a simple structured framework to resolve problems, improve systems, and to improve patient outcomes. These efforts are especially important in a resource-limited setting where infrastructure, staff and funds are meagre. The concept of QI often appears complex to a new careprovider who feels intimidated to participate in change activities. In this article, we describe our experience with QI activities to address various issues in the Neonatal intensive care unit. QI efforts resulted in improved patient outcomes, and motivated careproviders. QI is a continuous activity and can be done easily if the team is willing to learn from their experiences and use those lessons to adapt, adopt or abandon changes, and improve further. Our institute has also developed Point of Care Quality Improvement (POCQI), a free online resource for learning the science of QI, and also serves as a platform for sharing QI work.
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September 2018

Improving Duration of Kangaroo Mother Care in a Tertiary-care Neonatal Unit : A Quality Improvement Initiative.

Indian Pediatr 2018 Sep;55(9):744-747

Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.

Objective: To increase the duration of Kangaroo mother care (KMC) in preterm infants from an average of 3 hours/day to at least 6 hours/day over 7 weeks through a Quality improvement (QI) approach in a tertiary-care neonatal unit.

Methods: Preterm mother-infant dyads who were admitted in the Neonatal intensive care unit and KMC ward were enrolled in this study. A QI team comprising of nurses, nurse educators, resident physicians and nursing-in-charge of unit was formed. The potential barriers for prolonged KMC were evaluated using fish bone analysis. A variety of measures (allowing family members including male members during night for doing KMC, making KMC an integral part of treatment order, introducing the concept of weekly KMC champions, etc.) were introduced and subsequently tested by multiple Plan-do-study-act (PDSA) cycles. Data on duration of KMC per day was measured by bedside nurses on daily basis.

Results: 20 eligible mother-infant dyads were studied during implementation period (50 d). The mean (SD) weight and gestation of infants were 1199 (356) g and 31.1 ( 2.3) wks, respectively. We achieved our goal by step-wise implementation of changes through construction of 3 PDSA cycles. The duration of KMC increased to 6 hours-a-day over a period of 7 weeks. Evaluation at 6 and 12 months in the post-implementation phase suggested sustenance of improved KMC duration up to 9 h/day in the unit.

Conclusions: Ongoing quality improvement measures increased the duration of KMC from a baseline of 3 h to 6 h in eligible preterm infants, and the results were sustained at 6-12 month.
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September 2018

A Quality Improvement Initiative: Improving Exclusive Breastfeeding Rates of Preterm Neonates.

Indian J Pediatr 2017 Apr 24;84(4):322-325. Epub 2017 Feb 24.

Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.

This study is a single center quality improvement (QI) initiative in a tertiary care neonatal intensive care unit which was done with an objective to increase the proportion of neonates receiving mother's own milk (at postnatal age of 7 d) from the current rate of 12.5% to 30% over a period of six weeks. Additional objectives were to evaluate the proportion of mothers' expressing breast milk within 3 h of birth, on day one and three and the amount of expressed breast milk (EBM) on day one and day seven. A team was formulated to evaluate the reasons for inadequate breast milk expression and to plan the steps for promoting the same. Comprehensive postnatal breast feeding counseling (CPNC) to promote early breast milk expression was initiated soon after the birth of a preterm neonate. CPNC was done for next fifteen mothers and their breast feeding support was streamlined. The effect of CPNC and teamwork was discussed amongst the team members every day and adjustments incorporated (Plan-Do-Study-Act cycle). The proportion of neonates receiving mother's only milk (MOM) on day 7 increased to 80% (12/15) after 4 wk of QI. Thus, a simple and feasible CPNC package lead to improved breast milk output in mothers.
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http://dx.doi.org/10.1007/s12098-017-2306-4DOI Listing
April 2017

Reactive donor notification: First error reported.

Asian J Transfus Sci 2014 Jul;8(2):135-6

Blood Bank, Dr. Ram Manohar Lohia Hospital, New Delhi, India.

Donor notification and post-donation counseling is an essential role of blood bank. If a donor is reactive for any marker, the blood bank counselor, informs the donor and advices him/her to report to the blood bank for further counseling and management. The counselor at our blood bank informed a young female voluntary donor to be reactive for HIV both with ELISA as well as NAT. When the donor reported to blood bank, the repeat testing was negative and no history of high risk behavior could be elicited. The hospital information system (HIS) records were checked again immediately for clarification and showed consistency with her demographic profile. But when her manual records and donor questionnaire were retrieved, showed information displayed in the HIS system was wrongly interpreted by the counselor. In this era of information technology being highly advanced, the role of manual record keeping is still the gold standard.
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http://dx.doi.org/10.4103/0973-6247.137456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4140059PMC
July 2014

Apps for management of sick newborn: evaluation of impact on health care professionals.

J Trop Pediatr 2014 Oct 12;60(5):370-6. Epub 2014 Jun 12.

Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India

The objective of the study was to evaluate the efficacy of interactive mobile device application 'Apps on sick newborn care' as a training tool, in improving the knowledge and skill scores of postgraduate nursing students (N = 27). A training workshop was conducted in small workstations by the facilitators using the modules on android device and preloaded videos in which the procedure was systematically demonstrated. A mixed-methods approach consisting of pre-post tests, Likert's scale and focus group discussion were used to assess the knowledge, skills and perception of the participants. The scores in multiple choice questions (pre and post, 12.4 ± 2.2 and 19.7 ± 3.6; P < 0.001) and composite Objective Structured Clinical Examination scores (32.8 ± 7.3 vs. 63.7 ± 7.1; P < 0.001) significantly improved after training. The students derived overall satisfaction from the training using the device. Such applications have potential to train health-care professionals.
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http://dx.doi.org/10.1093/tropej/fmu032DOI Listing
October 2014

Comparing the Effectiveness of Webinars and Participatory learning on essential newborn care (ENBC) in the class room in terms of acquisition of knowledge and skills of student nurses: a randomized controlled trial.

Indian J Pediatr 2013 Feb 5;80(2):168-70. Epub 2012 May 5.

College of Nursing, All India Institute of Medical Sciences, New Delhi, 110029, India.

A randomized controlled trial was conducted in tertiary level center to compare the effectiveness of Webinars (WL) vs. Participatory learning (PL) on Essential Newborn Care (ENBC) in terms of acquisition of knowledge and skills of pre-service 6th semester student nurses. They were randomized to receive teaching on four topics of ENBC by two facilitators. Gain in knowledge and skill scores in ENBC were measured using validated assessment methods. Baseline characteristics including age, education, marks and hours of internet surfing were comparable between two groups (WL: n = 28, PL: n = 30). Pre-training mean knowledge scores in WL and PL group (mean ± SD) (30.96 ± 5.62 vs. 31.43 ± 4.74 p = 0.42), and skill scores (19.14 ± 3.37 vs. 19.20 ± 3.71 respectively, p = 0.77) were comparable. Training methods resulted in equal gain in knowledge in both groups. Satisfaction scores among the participants were also comparable. Thus, using webinars on ENBC as new technology in class room teaching may be an effective, alternative method to using participatory learning.
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http://dx.doi.org/10.1007/s12098-012-0742-8DOI Listing
February 2013