Strategies to sustain a quality improvement initiative in neonatal resuscitation in a district hospital in Gauteng province South Africa

Abstract

The neonatal mortality rate globally and in South Africa is high. South African district hospitals have the highest early neonatal mortality rates. Modifiable and avoidable causes contribute to this rate. The causes are associated with patient-related factors, for example, immaturity or illness, administrative factors such as inadequate facilities or equipment for resuscitation, and healthcare provider factors such as insufficiently trained or an insufficient number of staff. Competent resuscitation is a critical intervention for the survival of infants in need of respiratory or cardiac support in the neonatal period. The lack of neonatal resuscitation skills contributes to the high mortality rates in these settings. This multifaceted problem persists in spite of various neonatal resuscitation training in district hospitals. This prompted the following main research question: How can a quality improvement initiative in neonatal resuscitation be sustained in a district hospital in Gauteng? The aim of this study was to explore and describe the existing situation regarding neonatal resuscitation to enable the researcher and stakeholders in the specific district hospital in developing strategies to sustain the neonatal resuscitation quality improvement initiative in an effort to decrease neonatal mortality. In addition, to determine what changes occurred as a result of these strategies and whether these changes were sustainable. The Problem Resolving Action Research model was the methodology of choice and the National Health Service (NHS) Sustainability Model was used as the theoretical framework for the study. The study was conducted in three cycles. Each cycle answered a sub-question: CYCLE 1: What is the existing situation regarding factors influencing neonatal resuscitation and neonatal mortality in a district hospital in Gauteng? CYCLE 2: What strategies can be implemented to sustain a quality improvement initiative in neonatal resuscitation in a district hospital in Gauteng? CYCLE 3: What were the changes that occurred as a result of the strategies for a quality improvement initiative in neonatal resuscitation that were implemented? Were the strategies implemented to sustain a quality improvement initiative sustainable? A literature review was done to determine the background and rationale and for the purpose of literature control. Both qualitative and quantitative methods of data collection and analyses were used to determine the existing situation regarding neonatal resuscitation, develop and implement the strategies, and to evaluate the changes. Ethical considerations and methods to ensure trustworthiness and validity and reliability were taken into consideration and adhered to. Based on the findings it could be concluded that the strategies to sustain a quality improvement initiative in neonatal resuscitation had the probability of sustainability. Furthermore there was also a marked decrease in the neonatal mortality in the maternity section of this district hospital. Based on the findings the researcher was able to make conclusions and recommendations for practice, education and future research.