TIPS ON QUALITY ORGANISATION OF MATERNITY WING
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- TIPS ON QUALITY ORGANISATION OF MATERNITY WING
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Tips on quality
Organisation Of
Maternity Wing
12 Steps for a manager
March 2009
Abbriviation
ANC
Ante Natal Care
ANM
Auxiliary Nurse Midwife
BMO
Block Medical Officer
BMW
Bio Medical Waste
CHC
Community Health Centre
CS
Civil Surgeon
DH
District Hospital
DoHFW
Department of Health & Family Welfare
IMEP
Infection Prevention & Environment Protection
IPHS
Indian Public Health Standard
JICA/MP-RHP
Japan International Cooperation Agency
Madhya Pradesh-Reproductive Health Project
LHV
Lady Health Visitor
LR
Labour Room
MCH
Maternal and Child Health
NRHM
National Rural Health Mission/Reproductive.
OPD
Outdoor Patient Department
PHC
Primary Health Centre
PNC
Post Natal Care
SN
Staff Nurse
Preface
With the introduction of NRHM and subsequently Janani Suraksha
Yojna, quality of health services in the public health system is being
given much importance. It is essential that the maternity wing, which is
the most vibrant section in any facility, should be developed in a
standardized pattern. In this document we are addressing organizing the
maternity wing. It is being assumed that the ANC clinic and ANC/PNC
wards are well established in the facility.
Although providing health care is a technical issue, but promoting
standardized health care is more of a managerial issue. The 12 steps are
developed keeping in consideration that there are people associated with
the health programme who may not be health care providers themselves.
Following this document will help them in proceeding systematically
towards setting up a functional maternity wing.1
There are supporting aids developed by JICA - MP RH Project which are
requested to be used during this process. These are:
Illustrated Guidelines to operationalise delivery care at District
hospital, CHC/PHC
Handbook on Prasav mein dekhbhal
IMEP handbook
Posters on Parameters of ANC checkup. Breast feeding,
Kangaroo mother care. Wrapping the newborn, Handwashing,
Bio-medical waste disposal, Standard Treatment protocol
CD on Breast crawl (developed by Unicef Mumbai office)
,
I
While going through the steps, a manager may feel that (s)he is not
confident to give the technical instructions to the facility staff. In this
case, (s)he should take help of the facility in charge e.g. Civil
surgeon/BMO or a knowledgeable nursing staff.
. This booklet is developed jointly by DoHFW (M.P) and J1CA/MP-RHP
1 In a hospital Maternity wing should include the following areas: Antenatal clinic,
Labour room. Ante natal and Postnatal wards, Newborn care area.
1
Preface
With the introduction of NRHM and subsequently Janani Suraksha
Yojna, quality of health services in the public health system is being
given much importance. It is essentia] that the maternity wing, which is
the most vibrant section in any facility, should be developed in a
standardized pattern. In this document we are addressing organizing the
maternity wing. It is being assumed that the ANC clinic and ANC/PNC
wards are well established in the facility.
Although providing health care is a technical issue, but promoting
standardized health care is more of a managerial issue. The 12 steps are
developed keeping in consideration that there are people associated with
the health programme who may not be health care providers themselves.
Following this document will help them in proceeding systematically
towards setting up a functional maternity wing.1
There are supporting aids developed by JICA - MP RH Project which are
requested to be used during this process. These are:
Illustrated Guidelines to operationalise delivery care at District
hospital, CHC/PHC
Handbook on Prasav mein dekhbhal
IMEP handbook
Posters on Parameters of ANC checkup, Breast feeding,
Kangaroo mother care, Wrapping the newborn, Handwashing,
Bio-medical waste disposal, Standard Treatment protocol
CD on Breast crawl (developed by Unicef Mumbai office)
t
While going through the steps, a manager may feel that (s)he is not
confident to give the technical instructions to the facility staff. In this
case, (s)he should take help of the facility in charge e.g. Civil
surgeon/BMO or a knowledgeable nursing staff.
. This booklet is developed jointly by DoHFW (M.P) and JICA/MP-RHP
' In a hospital Maternity wing should include the following areas: Antenatal clinic,
Labour room, Ante natal and Postnatal wards. Newborn care area.
1
Step 1: Assess the capacity of the maternity wing
•
Look around how much space is being used to provide delivery
care in the facility. As per IPHS, standard Labour room size is
10x10 ft..
•
Lobour room should have a toilet attached to it.
•
Get approximate number of daily delivery load in the particular
facility, from the labour room records.
•
Establish relationship between the space available and delivery
load. If there are 5-6 deliveries per day, there is a possibility of
two deliveries at a time. In that case the Labour room should
have 2 tables.
•
Observe if the staff and family members can move around
freely in the labour room and wards. If there is difficulty in
doing so, it indicates crowding.
•
Maternity wing should not be situated in a secluded/isolated
area. There should be enough security for the staff on-duty and
the family members.
• Understand what are the related issue e.g. waiting space for
attendants, availability of functional toilets for patients and
staff, 2 staff on duty particularly on night duty etc.
•
Explore possibility of additional/altemate space if the currently
available space is inadequate.
•
A separate staff duty room should be available so that it is easy
for everybody to locate the staff in case of emergency.
•
Register, records, cards, referral slip etc. used in the maternity
wing should be available in the duty room.
• These should be filled by the staff on duty.
2
Step 2: Identify staff who is working in labour room
•
Find out staff (by name) who is actually working in labour
room. In many facilities ANM/LHV are deployed for outreach
. OPD.MCH clinic only.
•
List down the names of all the nursing staff who are posted
within the facility or reside there although being responsible
for outreach services or other SHCs.
•
Map the cadre of the staff i.e Staff nurse, LHV, ANM, Ayah,
Dai, Sweeper, counselor , birth companion etc who are
involved in providing services in the maternity wing.
•
Compare availability of nursing staff and ancillary with that of
the delivery load. There should be 2 nursing staff posted
exclusively in labour room at any point of time along with an
ayah and a sweeper.
•
Discuss with Civil Surgeon/BMO on fund availability for
contractual hiring.
3
Step 3: Assement of equipment/ instrument available in
maternity wing
•
Observe what ail relevant equipment/instruments you can spot
in the labour room(Make a list as per Illustrated Guidelines
developed by JICA project).
•
Observe furniture,' equipment, instrument which are lying
unused in the facility.Facilate to remove them.
•
Visit the facility store to see what is available regarding
furniture, equipment, medicine etc relevant to maternity wing.
•
Discuss with the facility incharge regarding items those are
available in the facility but lying unused. With his consensus,
these can be shifted to the maternity wing.
•
Identify how many instrument are in working condition and
how many need repair or replacement.
•
Discuss with the facility in-charge on availability of funds for
repair maintenance of the supplies.
4
Step 4: Physical arrangement of labour room
• Ask the staff of maternity wing to collect the necessary
equipment/ instrument in the labour room if possible..
• Orient them on the need of establishing 4 comers i.e
observation comer, service station ,delivery room and new bom
comer.
• Discuss with the staff where these 4 comers can be established
within the maternity wing.
•
Facilitate actual establishment of these comers
• Refer to the Illustrated guidelines for DH/CHC/PHC
(developed by JICA Project) to facilitate the establishment in a
systematic and standardized way.
• Support the staff in preparation of duty roaster for the facility
(Civil
surgeon/BMO
to
be
taken
into
confidence).
All the nursing staff i.e. ANM/LHV/SN should be involved to
provide services in the maternity wing. Duties for ANMs/LHVs
responsible for the outreach as well should be fixed keeping in mind
their field activities. A sample duty roaster is given on next page:
5
Duty roaster
Name of facility—.................. .............
Day
Date
■
Roaster duration--------------
8 am- 2 pm
2 pm-8 pm
Labour OPD/MCH
clinic or
room
general
ward
Labour
room
OPD/
MCH
clinic
8 pm - 8 am
Labour General
ward
room
Doctor on
call
(Name
&
Phone No.)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Note: Duties will be changed only with prior permission
Being absent from the duty without sanctioned leave shall be considered as absent
Duties can be swapped mutually only with prior intimation to the Maternity wing incharge
Implementation of duty roaster is the responsibility of Maternity wing in-charge
Signed
Signed
Maternity wing in-charge
CS/BMO
6
o
Duty roaster should be displayed at the Labour room.
°
Discuss the issue of nominating a Maternity wing InCharge with CS/BMO. This will ensure smooth working
and a fixed focal person for management.
o
Help the staff in identifying the maternity wing in-charge
in consensus with the Civil surgeon/BMO and the staff.
0
Ensure availability of “handing over/taking over” register
is maintained in the Labour room. A sample of it given
below:
DATE:
Shifts
Staff
on
duty
LR
Details
ANC
Ward
PNC
Ward
8 am 2 pm
2 pm8 pm
8 pm 8 am
7
Supplies
Referral
Remark
• Appraise the CS/BMO about the improvisations if he was not
able to attend the discussion.
Note: The next steps are for actual establishment of the wing. It needs
to be kept in mind that these steps have to be carried out in your
presence and cannot be left for the facility staff to follow later. In the
future visits, it should be followed that the modifications are being
practiced. The box below shows which steps correspond to which
service area.
Note: Steps corresponding to establishment of the “4
corners”are
Observation corner : Step 5
Service station
: Step 6,7
Labour corner
: Step 8,9,10
Newborn corner
: Step 11,12
8
Step 5: Establishing the Observation corner
o
Confirm with the staff space designated for the Observation
comer.
®
Orient the staff on the need of establishing this comer.
®
Discuss with them the convenience in working by establishing
this area.
®
Refer the Illustrated Guidelines for DH/CHC/PHC part 1 to
arrange items in this area.
o
Listen to the suggestions given by the staff and improvise if
needed.
9
Step 6: Arrangement of 5 trays in the labour room
• Ask the staff which trays should always be
labour room.
available in the
• Orient them on the essential 5 trays i.e. delivery tray, episiotomy
tray, baby tray, medicine tray for delivery and emergency drug
tray. As you can see this is the sequence of activities in the Labour
room, hence they should be kept ready before hand.
• Allow them to put things in each tray as per their understanding.
• Share the standard list after they have finished organizing the
trays and facilitate to rearrange it.
• Orient them on scientific name and use of each
instrument/equipment. Take help of the Medical Officer here.
•Ask them to mark the missing things and put them in the
respective trays.
•Help them in identifying the item which are not available in the
facility. They should prepare a list of these items.
• Share the list of items with the Maternity wing incharge so that
these can be made available.
10
Step 7: Ensuring the infection prevention in the labour
room
•
Discuss with the staff what are the various practices of infection
prevention to be observed in the labour room (hand washing,
sterilization, using gloves/gown/cap mask, & color code waste
bins).
•
Ask them to arrange all the sterilization equipment items in the
labour room,
•
Help the staff to establish facility for hand washing.
•
Orient them on all infection prevention techniques (starting from
hand washing and proceeding to sterilization)
•
Ask them to prepare the list of items/ supplies needed to practice
infection prevention in the labour room.
•
Share this list with the facility in charge so than he can make it
available.
•
Discuss with them how many drums are needed and containing
what items (gloves, cap mask, gown, linen, instruments, gauze and
pads, cotton, silk threads for suturing and cord tie).
•
Demonstrate how to prepare each drum.
•
Ask them to label indicating contents in each drum if the drums
are already prepared.
Step 8: Establishing the Labour corner
•
Look around the labour room and assess if 2 labour tables can be
placed there.
0
Ask the staff to move around in the labour room from one “comer”
to the other. There should ease of moving around.
®
Refer the Illustrated guidelines DH/CHC/PHC part 1 to arrange
items in this area.
°
Discuss with them the convenience in working by establishing this
area.
°
Listen to the suggestions given by the staff and improvise if
needed.
°
Display Standard Treatment Protocol posters in the labour room.
•
Also display posters on newborn care, breast feeding, postnatal
care and nutrition.
•
To show short health education flims, TV should be made
available.
12
Step 9: Usage of Partograph
•
Observe if partograph is being plotted for each delivery case.
•
Analyse the partograph, if plotted, is correctly done.
•
Orient the staff on plotting of the partograph (use guidelines
and case examples to make them understand)
•
Give them case studies to practice plotting.
•
Ask them to make arrangement near each labour table to hang
the partograph.
•
Inquire if the facility has sufficient quantity of printed
pantographs.
•
Share the identified gaps with the facility in-charge so that he
can bridge them.
13
Demonstration of Infection Prevention
Step 10:
procedures
0
Ask them to do peer group demonstration of the following
procedures one-by-one
o
Handwashing
o
Disinfection of latex gloves
o
Making sanitary pads
o
Putting waste in colour coded bins and respective bins.
o
Cleaning of vulva
o
Preparation of 0.5% Chlorine solution
o
Wearing and taking out gloves
o
Wearing sterile apparel
o
Preparing material to be autoclaved
®
Ask others to observe each procedure closely.
®
Refer to the Prasav mein dekhbhal skill checklist, BMW
posters and IMEP handbook to monitor the correct steps
for each procedure.
•
Discuss which steps were not correct in the procedure
(observers should share their views after the procedure is
over and not interrupting in between)
•
Orient them on correct step of each procedure.
•
Ask them to demonstrate each procedure correctly once
again.
14
Step 11: Orientation on Newborn care equipment
®
Request the staff to bring all the needed equipment for
newborn care in the maternity wing.
•
Ensure that the electricity points are functional.
•
Orient the staff on usage and maintenance of these equipment
using the Illustrated Guidelines for DH/CHC/PHC part 2.
•
Help them to list essential equipment which are not available
in the facility.
®
Help them to list out other related facilities to make the
newborn comer operational e.g. sufficient electricity points,
back up electricity support etc.
®
Share the list with the facility in-charge so that he can make
the things available
15
Step 12: Demonstration of Newborn care skills
•
Ask the staff to demonstrate the following procedures one by- one:
Wrapping a new born. Kangaroo mother care,
Breast feeding
®
Ask the other staff to observe and share their views after the
procedure is over.
0
Discuss which steps were not correct.
•
Demonstrate each procedure step-by-step explaining each one.
°
Take them to the post natal ward and ask them to repeat the
procedures on the admitted cases.
®
Show CD on “Breast Crawl” if available.
16
JICA/MP-REPRODUCTIVE HEALTH PROJECT
22, Nadir Colony, Shamla Hills, Bhopal-462013 (M.P)
Phone: +91 755 2661960 Fax: +91 755 2661961
Website: www.jicamprhp.org
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