Table 3 ‘Improved oxygen system’ intervention components, purpose, and description
Intervention component | Purpose(s) | Description |
|---|---|---|
Standardised equipment package oxygen concentrator pulse oximeter oxygen delivery equipment maintenance gear | To enable reliable, continuous access to oxygen for all children and neonates To make it easy to use oxygen correctly To make it easy to maintain oxygen equipment in good function | Selection of quality, user-friendly equipment that is proven to function in hot, humid environments and capable of being maintained with minimal technical skill: Airsep Newlife Elite oxygen concentrator, Lifebox pulse oximeter (neonatal and child probes), Airsep Sureflow flowmeter assembly, nasal prongs and tubing, oxygen analyser, installation and maintenance gear |
Clinical education and support basic oximetry training healthcare worker training on the clinical use of oxygen supportive supervision | To build healthcare worker capacity and motivation to use oxygen well To stimulate healthcare workers to make their work environment more conducive to good clinical care | Clinical training material based on WHO guidelines [35, 48] and will include: clinical approaches to sick children; recognition and treatment of hypoxia; use of pulse oximetry and concentrators. Using Merrill’s approach to active learning [31], training will be active, task-based, and intentionally target motivation. Training conducted on-site at participating hospitals. One-hour basic pulse oximetry training for nurses and physicians when pulse oximeters are distributed. Half-day training on the clinical use of oxygen at the time of installation, using an ‘apprentice’ model where individual leaders are trained first, and then they are supervised to train their colleagues (and coordinate future re-training) |
Technical training and support technician training on maintenance and repair supportive supervision | To build technician capacity and motivation to maintain and repair equipment To stimulate technicians to modify their procedures to make equipment care easier | Technical training material adapted from previous projects [12, 14, 15] and delivered by an expert biomedical engineer. Three-day training conducted at a central location for central engineers and at least one technician from each participating hospital. Regular supervision visits (at least 3 monthly) for re-training, review and feedback, and to identify areas needing additional attention |
Procurement, installation, and maintenance structures procurement advice and support installation support maintenance procedures financing procedures | To enable reliable, continuous access to oxygen for all children and neonates To build hospital team capacity to maintain and scale up oxygen systems. To strengthen hospital’s technical capacity to maintain and repair equipment To make oxygen therapy affordable for both patients and hospitals | Uniform equipment procurement led by coordination team, in collaboration with participating hospitals Equipment installation led by central technical team in collaboration with participating hospitals, and delivered in partnership with technicians from participating hospitals Equipment procedures and forms developed by coordination team in collaboration with participating hospitals. A comprehensive maintenance plan must involve the provider, installer, engineer, local technician, and local clinical staff (including timely access to technical support) Local challenges identified during participatory planning, and addressed by local hospital teams Cost-analysis conducted by coordination team with hospital-level data, and recommendations made for action by hospital administrators |
Infrastructure support improved power supply (e.g. solar power) | To ensure reliable, continuous access to oxygen for all children and neonates. To make it easy to maintain oxygen equipment in good function | Improved power system using solar capture and/or battery storage and/or generator back-up. The exact configuration has not been pre-specified, but will be based on hospital-level power evaluations, and recommendations from expert engineers/technicians (including mathematical modelling). Power system should be effective, efficient, user-friendly, and able to be maintained by local technicians. Other potential needs may include: secure storage areas, enhanced security arrangements, workspace modification, etc. |
Strengthening health information systems clinical documentation medical records | To strengthen broader care processes. To strengthen managerial support for oxygen therapy. | Support nursing and medical staff to improve documentation (e.g. adapt monitoring charts to include peripheral capillary oxygen saturation (SpO2)) Support medical records staff with record keeping and reporting (e.g. basic electronic health reporting system on computer) |
Strengthening quality improvement processes continuing education and morbidity review demonstrating quality improvement process quality improvement team building | To strengthen broader care processes To strengthen managerial support for oxygen therapy To build and sustain healthcare worker capacity and motivation to provide good clinical care To stimulate healthcare workers to make their work environment more conducive to good clinical care To build hospital team capacity to maintain and scale up oxygen systems | Support ongoing education and clinical review activities, including retraining as staff rotate Demonstrate behavioural and structural changes regarding oxygen therapy. Encourage development, and support function, of multidisciplinary teams at the hospital level Embedded project nurse within each hospital to collect data, and support project activities |