Afr J Prim Health Care Fam Med. 2025 Apr 23;17(1):e1-e14. doi: 10.4102/phcfm.v17i1.4742.
ABSTRACT
BACKGROUND: Continuous positive airway pressure (CPAP) therapy is the standard of care for neonatal respiratory distress and improves survival when implemented in low-resource settings. Clinical audits at the Borama Regional Hospital (BRH) Neonatal Intensive Care Unit (NICU) revealed multiple barriers to effective CPAP, including insufficient pressure, a lack of neonatal-sized nasal prongs, and patient interface challenges.
AIM: Improve respiratory distress by increasing effective CPAP delivery for neonates 30 days of age from 52% to 90% in 6 months.
SETTING: Single-centre referral hospital in the Awdal region of Somaliland.
METHODS: Quality improvement (QI) initiative with outcomes displayed using statistical process control (SPC) charts.
RESULTS: Eleven residents, three medical interns and seven NICU nurses completed the educational training. Forty-five patients were initiated on the locally designed bubble CPAP (bCPAP) device with a 47% (122/261) CPAP safety checklist completion rate for the three daily nursing shifts. We achieved our study aim by increasing the adherence rate to the 7-item bCPAP device set up from a baseline of 52% to 91%. The rate of infants weaned or discontinued from bCPAP for improved respiratory severity score (RSS) increased from 0% to 18% but did not demonstrate process change. There was no increase in adverse event rates (air leak, nasal columella breakdown and nasal irritation).
CONCLUSION: We demonstrated increased effective bCPAP delivery and decreased respiratory distress.Contribution: This study outlines low-cost, customisable QI strategies to address commonly encountered gaps for effective bCPAP delivery in low-resource settings without access to commercially available CPAP devices or speciality-trained providers.
PMID:40336423 | DOI:10.4102/phcfm.v17i1.4742
