Increasing postpartum IUCD coverage through a QI initiative: a step towards reducing the unmet need of postpartum contraception

BMJ Open Quality

article

Swati Agrawal¹  Manju Puri¹  Anuradha Singh¹  Sushma Sehrawat¹  Shilpa Sood¹  Kavita Choudhary¹  Anu Handa¹  R Induja¹  Apurwa Bardhan¹  Pooja Luthra¹  Preeti Pawar¹  Nidhi Singh¹  Swati Tyagi¹  Jismaria Antony¹  Priyanka Arora¹  Sukriti Ghai¹  Tanya Shubham¹  Vaishali Suraiya¹  Surabhi Sapna¹  Mani Ajithkumar¹ 

[1] Obstetrics & Gynaecology , Lady Hardinge Medical College

关键词: maternal health services;    obstetrics and gynecology;    quality improvement;    teamwork;    women's health;   

DOI  :  10.1136/bmjoq-2021-001346

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Background Unintended pregnancies have a negative impact on the health and economy of a nation, which can be prevented by effective family planning (FP) services. Postpartum intrauterine device (PPIUCD) is a safe and effective FP method which allows women to obtain long-acting contraception before discharge from the point of delivery. We observed poor coverage of deliveries with PPIUCD at our facility. This was the trigger to initiate a quality improvement (QI) initiative to increase the PPIUCD coverage from current rate of 4.5%–10% in 3-month period.Method A fishbone analysis of the problem was done and the following causes were identified: lack of focused counselling for FP, lack of sensitisation and training of resident doctors and inconsistent supply of intrauterine contraceptive devices (IUCDs). A QI team was constituted with representatives from faculty members, residents, interns, nursing officers and FP counsellors. The point of care quality improvement methodology was used.Interventions Daily counselling of antenatal women was started by the counsellors and interns in antenatal wards. A WhatsApp group of residents was made initially to sensitise them; and later for parking of problems and trouble shooting. The residents were provided hands-on training at skills lab. Uninterrupted supply of IUCDs was ensured by provision of buffer stock of IUCDs with respective store keepers.Result The PPIUCD insertion rates improved from 4.5% to 19.2% at 3 months and have been sustained to a current 30%–35% after 1 ½ years of initiation of the project tiding through the turbulence during the COVID-19 pandemic using QI techniques.Conclusion Sensitisation and training of residents as well as creation of awareness among antenatal women through targeted counselling helped improve PPIUCD coverage at the facility. QI initiatives have the potential to facilitate effective implementation of the FP programmes by strategic utilisation of the resources.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND