Evaluation of Helping Babies Breathe Quality Improvement Cycle (HBB-QIC) on retention of neonatal resuscitation skills six months after training in Nepal

Abstract

BackgroundEach year 700,000 infants die due to intrapartum-related complications. Implementation of Helping Babies Breathe (HBB)-a simplified neonatal resuscitation protocol in low-resource clinical settings has shown to reduce intrapartum stillbirths and first-day neonatal mortality. However, there is a lack of evidence on the effect of different HBB implementation strategies to improve and sustain the clinical competency of health workers on bag-and-mask ventilation. This study was conducted to evaluate the impact of multi-faceted implementation strategy for HBB, as a quality improvement cycle (HBB-QIC), on the retention of neonatal resuscitation skills in a tertiary hospital of Nepal.MethodsA time-series design was applied. The multi-faceted intervention for HBB-QIC included training, daily bag-and-mask skill checks, preparation for resuscitation before every birth, self-evaluation and peer review on neonatal resuscitation skills, and weekly review meetings. Knowledge and skills were assessed through questionnaires, skill checklists, and Objective Structured Clinical Examinations (OSCE) before implementation of the HBB-QIC, immediately after HBB training, and again at 6 months. Means were compared using paired t-tests, and associations between skill retention and HBB-QIC components were analyzed using logistic regression analysis.ResultsOne hundred thirty seven health workers were enrolled in the study. Knowledge scores were higher immediately following the HBB training, 16.4 ± 1.4 compared to 12.8 ± 1.6 before (out of 17), and the knowledge was retained 6 months after the training (16.5 ± 1.1). Bag-and-mask skills improved immediately after the training and were retained 6 months after the training. The retention of bag-and-mask skills was associated with daily bag-and-mask skill checks, preparation for resuscitation before every birth, use of a self-evaluation checklist, and attendance at weekly review meetings. The implementation strategies with the highest association to skill retention were daily bag-and-mask skill checks (RR-5.1, 95% CI 1.9–13.5) and use of self-evaluation checklists after every delivery (RR-3.8, 95% CI 1.4–9.7).ConclusionsHealth workers who practiced bag-and-mask skills, prepared for resuscitation before every birth, used self-evaluation checklists, and attended weekly review meetings were more likely to retain their neonatal resuscitation skills. Further studies are required to evaluate HBB-QIC in primary care settings, where the number of deliveries is gradually increasing.Trial registration ISRCTN97846009. Date of Registration- 15 August 2012.

Does the Helping Babies Breathe Programme impact on neonatal resuscitation care practices? Results from systematic review and meta‐analysis

“…Four articles were not included in the review even though they matched the inclusion criteria as they were covered in the above four studies. The Wrammert 2017 is covered in KC 2016 ; Ersdal 2013 , Mduma 2015 and Vossius 2014 are covered in Msemo 2013 .…”

“…Several studies have reported improved perinatal outcomes at birth due to the implementation of the HBB programme . Several lessons have been learned from implementing the programme in health facilities and community settings .…”

Perinatal outcomes following Helping Babies Breathe training and regular peer–peer skills practice among village midwives in Sudan

“…In Tanzania, Msemo et al 8 showed a 47% reduction in  24-hour early neonatal deaths (ENND) and 24% reduction in fresh stillbirths (FSB) following continued refresher HBB training (HBBT), while Goudar and colleagues showed a 46% reduction in FSB in India 9 10. In Nepal, Kc et al 11 observed a reduction in FSB and 24-hour ENND through repeated quality improvements cycles of HBBT, while Mduma et al 12 showed that frequent brief on-site HBBT was associated with a reduction in 24-hour ENND in a rural hospital in Tanzania. Incorporating early newborn care education into newborn resuscitation training was associated with reductions in 24-hour ENND in Zambia 13.…”

Improving Global Newborn Survival: Building upon <b><i>Helping Babies Breathe</i></b>

“…Among the effective practices identified, self-reflection by individual providers on each resuscitation performed is one of the simplest associated with positive change in outcomes. Monitoring and case review with weekly quality meetings can develop a culture of local data collection and use and help shift the narrative from punitive management practices to shared efforts toward more efficient and effective care [18, 19]. Debriefing, including use of video recordings, has been used in a variety of settings [18-22].…”

“…Monitoring and case review with weekly quality meetings can develop a culture of local data collection and use and help shift the narrative from punitive management practices to shared efforts toward more efficient and effective care [18, 19]. Debriefing, including use of video recordings, has been used in a variety of settings [18-22]. The transportability and generalizability of quality improvement approaches have been demonstrated in a cluster randomized trial among district hospitals in Nepal [23].…”