Neonatal Nursery Norms and Standards

Dolly Nyasulu

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Introduction

• Guidelines have been set in order to provide high quality of care

• Norms and standards are developed from these guidelines in the form of protocols, policies etc.

• The quality of care can be measured against the norms and standards.

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Norms and standards for newborn care in public hospitals

• Number of beds

• Staffing

• Infrastructure

• Equipment

• Consumables / drugs

• Resuscitation requirements

• Care provided

• Monitoring and evaluation

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All hospitals should have:

• Nursery- where sick or small babies are admitted

• KMC unit – For stable low birth weight babies

• Rooming in with mothers for well babies

• Well baby nursery for babies with sick mothers, abandoned babies and in some case where the mother.

Norms and standards for bed allocation

The number of beds allocated for each hospital is based on:

• The hospital level of care ie. Tertiary; Regional; District.

• The number of local population (total hospital beds)

• The number of deliveries (neonatal beds)

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Norms and Standards for KZN District Hospitals

Beds: Number of deliveries in catchment area including clinic deliveries

Bed Norm Set Out

Total Beds 3 per 1000 deliveries

High Care Beds 1 per 1000 deliveries

General Beds 1 per 1000 deliveries

KMC 1 per 1000 deliveries

Norms and standards for Staffing Cont.

Each district hospital must have a dedicated prof nurse for each shift.

50% of staff must not be rotated

A full time MO must be responsible for Neonatal & KMC units for a minimum of 6 months

Sr in charge must have appropriate qualifications ( ADM)

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Example: District hospitals with differing number of beds

Beds PNs ENs

High care

General KMC

2 2 2 1 2

3 3 3 2 2

4 4 4 2 2

5 5 5 2/3 4/3 8

Infrastructure norms and standards

• Neonatal unit must be distinct from maternal components with a single access point and strict security.

• Hand basin on entry to the unit and a hand basin for every 6 bed cubicle.

• Room temperature to be maintained at 24-26 C.

• Space between incubators (1,5m and 5,0m)

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Infrastructure norms and standards (cont)

• Separate room with social space for KMC

• 7.5 m space between beds

• Resuscitation equipment to be available and in a good working condition.

• KMC beds to be occupied by KMC mothers and not postnatal mothers

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Resuscitation Norms and Standards

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Item Nursery KMC L/ward PNC Theatre OPD

Fully Functional Resus Trolley

1 1 1 1 1 1

Resuscitaire 1 1 1 1 1 1

Laryngoscope with straight blades (sizes 0 &

00)

1 1 1 1 1 1

Neonatal Ambu bags and round silicone masks (sizes 1, 00, 0)

1 1 1 1 1 1

Oxygen & Oxygen tubing

1 1 1 1 1 1

ET tubes (uncuffed) (Sizes 2,5 3,0 3,5)

3 3 3 3 3 3

Suction Unit & Tubing

1 1 1 1 1 1

Equipment Norms and Standards Item General Bed High Care Bed

Infusion Pump 1 2

Oxygen points 1 1

Syringe Pump 1 2 (4)

Multi parameter Monitor (TPR;SpO2;NIBP)

1 1

Multi parameter Monitor (ECG,BP,SATS.TPR)

1 1

Phototherapy lights 0.2 0.5

Nasal CPAP 1 2

Consumable Norms and Standards

• Consumables should be accessible in nursery and items not expired.

• For resp care: CPAP circuits; ET Tubes; Nasal cannula, Oxygen tubing and suction apparatus

• One month’s supply must be available

• For monitoring: sats probes; temp probes; cardiac leads; disposable BP cuffs

• For IV and Bloods: Blood giving sets; T-Extension sets; IV Cannula; Umbilical Catheter 5.0FG

• For Syringe pump: 50ml syringe dedicated for the pump

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Care Norms and Standards

• 3 hourly observations

• 3 hourly glucose monitoring

• 12 hourly observations on C/S babies

• Daily weights / Growth Monitoring

• Calculating, administering and monitoring of IV fluids

• Standard referral / discharge guidelines.

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Monitoring and Evaluation Norms and Standards

• Monthly Record Audits

• Monthly Infection control audit

• Monthly hand washing audit

• Record action plans from audits

• PPIP and DHIS Review

• On going quality improvement assessments

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Resource Materials

• SAINC Chart books

• Newborn Tool Kits

• NELs

• KINC

• LINC

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