EINC - A Step-By-Step Guide
EINC - A Step-By-Step Guide
EINC - A Step-By-Step Guide
Skin-to-skin Contact
Real Breastfeeding Initiation
120%
100% 80% 60%
ENC TRAINING
40%
20% 0%
BLADE
NGT Cotton Alcohol Betadine Distilled Water IVF (1L)
P3
P7 P 2.50 P5 P5 P 11.50 P 52.50
6,670 x P465.50 =
P 3,104,885/yr
or
IV Set
IV Catheter
P 14.50
P 11.50
Suture
Flet Enema
P 97
P 200
P 258,740.72
per month
P5
P 36 P 15
TOTAL
P 465.50
M: 0.25 (0.08-0.77)
Skin-to-Skin Contact
M: 0.00
11
Antenatal
At least 4 antenatal visits Iron and folate supplementation Tetanus Toxoid Vaccine Prepare a BIRTH PLAN including UnangYakap
Identify mothers in PRETERM LABOR at point of entry Administer 1st dose of Antenatal Steroid History, Physical Exam and Vital Signs Obtain Birth Plan, Determine Companion of choice Allow Position of Choice Use Partograph to monitor labor IV fluid and NPO only when indicated Arrange all instruments in a linear fashion Check resuscitation equipment
During Labor
Clean hands after touching a patients objects even if the patient wasnt touched
1. Wet hands with warm running water, apply soap and lather well. 2. Rub each area together counting 1-2-3-4-5
Time
Delivery
Mother
Support the perineum with controlled delivery of the head
Baby
Call out time of birth and sex Dry, check breathing
Support FIRST FULL BREASTFEED. Monitor as a DYAD q15 minutes 15-90 minutes Continue uterine massage; Monitor every 15 minutes Do PE, weigh, measure, eye care, inject Vit K, Hep B, BCG
Optional: Bathing
Immediate and Thorough Drying Early Skin to Skin Contact Properly-timed Clamping Non-Separation of Mother and Baby
20
Normal Delivery?
24
Websites
Download the Essential Newborn Care (ENC) Training Videos from:
www.doh.gov.ph ://www.wp://www.wpro.who.int/philippines/PubDocs.h tm http://www.wpro.who.int/philippines/PubDocs.htm
EINC Implementation
1. Organize a multidisciplinary EINC Working Group Clinical staff Physicians - OB, Pedia, Anesthesia, Infection Control Nurses, nursing assistants, midwives
Administrative staff Medical Director Finance/ Budget Officer PhilHealth Officer Medical Social Service Engineering CSR
EINC Implementation
2. Conduct a situational analysis of your facility
Time and motion studies of deliveries and immediate newborn care practices
May be done periodically to determine effectivity of program implementation 3. Conduct saturation training workshops for all staff involved in maternal and newborn care services
DR/OR, NICU, OB and Pedia Wards, ER staff Institutional/ utility workers
EINC Implementation
4. Revise hospital policies and procedures
Allow companion of choice Remove footprinting Revise Nursery admission/ discharge criteria - weight or gestational age limits for preterms - growers Review newborn policies on diagnosis and management e.g. potential sepsis hyperbilirubinemia
EINC Implementation
5. Realign hospital staff to do new tasks
Obstetrician to dry the baby Pediatrician to clamp and cut the cord Anesthesiologist to help in maintaining skin-to-skin contact DR/ NICU staff to monitor mother and baby dyads DR/ NICU nurse to weigh baby and to do eye prophylaxis, IM injections Utility worker to transfer mother-baby dyad together
EINC Implementation
6. Revise hospital forms and order sheets Incorporate EINC in the newborn admission forms, modify newborn admitting orders, checklist Utilize a mother-baby dyad monitoring sheet Breastfeeding and Danger Signs Checklist
EINC Implementation
7. Enable the environment for EINC
Provide ample space in the labor room for companion, for mothers mobility Provide back support for upright positioning Include bonnet/extra linen in the OB pack Designate an EINC Recovery Room or area
8. Disable the environment that hinders EINC Remove the transitional nursery provide trolley Close the Nursery!
Help us bring
to your community
To 7 days
II II Essential Newborn
From 90 min to 6 hours
Breastfeeding Warmth of the Baby Hygiene Sleeping Danger Signs: serious illness Signs of Jaundice and Local Infection Discharge Instructions
IV
V V Additional Care
A. Newborn Resuscitation B. Additional Care of a Small Baby (or Twin): Warmth, feeding support, KMC, discharge planning C. Dealing with Feeding Problems: Mother-infant separation, manual expression of breastmilk, cup feeding
VI VI
Preparing for the shifts workplace After every delivery restock Standard precautions general standard precautions and cleanliness Hand hygiene Processing Instruments & Other Items: Step 1: Decontamination Step 2: Cleaning Step 3: High-Level Disinfection by Boiling or Steaming Sterilization by Steaming (Autoclave) Step 4: Store or Use
Warm and clean room Handwashing Waste Sterilization Supplies Miscellaneous For the Mother and Baby equipment, delivery instruments, drugs, supplies, forms & records, plus for CEmONCs
www.wpro.who.int/philippines/PubDocs.htm
41