Indian Academy of Pediatrics

1 Indian Academy of Pediatrics IAP-AAP-LDSC First Golden Minute Project Basic Newborn Care and Resuscitation Program For Private sector Administrative Manual Compiled by Naveen Thacker Vineet Saxena Rhishikesh Thakre Alka Agarwal CP Bansal Sailesh Gupta NC Prajapati Tanmay Amladi 1

2 INTRODUCTION In the next 3 years several courses on Basic Newborn Care and Resuscitation Program developed under the aegis if IAP NRP FGM (Indian Academy of Pediatrics Neonatal Resuscitation Program First Golden Minute) will be conducted in the private sector in India with an academic grant from Johnson and Johnson India Ltd. The program is based on the AAP Manual of Neonatal Resuscitation Program, and jointly developed by IAP, AAP, LDSC, and GOI. There is a need for an ongoing Basic Newborn Care and Resuscitation Program in every city / district, and convincing health professionals about that need may prove to be a challenge. COURSE COORDINATION Every Basic Newborn Care and Resuscitation Course will be coordinated by a Course Coordinator. The Course Coordinator would preferably be the President of the Local Branch of IAP or a person identified by him in consultation with State Academic Coordinator. This guideline document provides suggestions for step-wise planning of a course by the Course coordinator, including a sample timeline, a discussion of pre-course administrative details, selection of a program format, and organization strategies for Basic Newborn Care and Resuscitation Program course supplies and equipment. The preparation routine will vary with the course type, format, and number of participants involved. All the Instructors must wear aprons (Laboratory white coat) and the IAP FGM Instructor s Batch during the course. FAQs ABOUT PRE-COURSE PLANNING o How do I justify the need for a Basic Newborn Care and Resuscitation Program course in my region, and how do I identify potential beneficiaries? Answer. The Basic Newborn Care and Resuscitation Program under IAP NRP FGM is designed primarily for those who participate in neonatal resuscitation in the delivery room, and provide care for newborns in maternity and general hospital facilities. To identify 2

3 potential beneficiaries of the course, a list of maternity and general facilities (where-in maternity facilities are offered) in a city / district can be prepared. This can be done with the help of the local government and municipality. Birth records can be obtained on request from the medical officers of local municipal bodies to garner names of facilities (public, private, and corporate) where the babies were born. Many births are reported as home deliveries which are mostly attended by unqualified attendants including Dais (TBAs). A database can be created from the information gathered, which should include names of health professionals, their medical qualifications, their operational facility, contact details, workload (number of deliveries conducted in a month) etc. They are requested to fill out an 'experience survey' form and analyze the results. Based on the result candidates may be chosen for training. o What type of course is needed? Answer. The Basic Newborn Care and Resuscitation Program for Private Sector under IAP NRP FGM Project offers two types of courses - 1) Provider Course 2) Instructor Course A Provider course is designed for healthcare professionals involved in any aspect of newborn care and neonatal resuscitation. This usually includes Pediatricians, Obstetricians, Anesthetists, Medical officers, Staff Nurses and Paramedic staff in private hospitals. This course teaches a stepwise approach to basic neonatal resuscitation and care of the newborn at birth. An Instructor course is designed to create Instructors for Basic Newborn Care and Resuscitation Program, who can further impart Instructor and Provider courses to potential candidates in either category. Participants for Instructor course must be carefully chosen considering their experience of working in maternity and neonatal facilities, and must successfully complete the training, along with an instructor component as per their instructor level. 3

4 TYPES OF COURSES A) Basic Newborn Care and Resuscitation Program Provider Course: This course is based on lessons 1 to 6 of NSSK Training Manual of Basic Newborn care and Resuscitation Program (MOHFW, GOI, 2009) and is meant for poor resource settings where skilled manpower and / or instruments are not available. This will be translated in all regional languages of India. Manuals in regional languages are essential for training of Nurses, ANMs and paramedic workers of private medical facilities. Recommended course length The length of Basic Newborn Care and Resuscitation Program Provider course is about 18 hours spread over two days. Preparations before a Course - FAQs o How should I choose a location for Basic Newborn Care and Resuscitation Program course? Answer. While deciding location one should keep the following facts in mind - There should be one Class Room for lectures; preferably with facility for audiovisual equipment (DVD Player is essential, while a Laptop and LCD Projector are preferable, but non-essential). Alternatively, a TV set with DVD player may be use to run videos. There should be enough rooms to run five Skill Stations simultaneously the noise at one skill station should not distract the participants at another skill station. It is advisable to keep these courses in Hospitals where an ideal venue can be created. However, in some instances, an ideal venue may not exist for the Basic Newborn Care and Resuscitation Program course. As an Instructor of Basic Newborn Care and Resuscitation Program, one may need to be flexible and creative under challenging conditions. 4

5 o What is the number of faculty members required for the Basic Newborn Care and Resuscitation course? Answer. There must be enough Instructors to support all learners. The recommended ratio is One Instructor for every 6-8 learners. o How do I procure course manual, other NRP training material and ensure availability of Manikins for training? Answer Each learner is required to have access to a copy of Course Training manual. Please get in touch with your State academic coordinator / Zonal coordinator for supply of manuals and manikins for training. o How should I manage the administrative aspects of the course? Answer. Prepare an excel sheet with the registrant s name, complete address, phone number, e mail id, and professional discipline. This is important for completing the Basic Newborn Care and Resuscitation Program FGM Course Roster. You will also use the information for sending each registrant a confirmation letter, and for creating an attendance sign-in sheet. Through the letter of confirmation, the registrant should be reminded of the course date, time, location, and course time table. o What are the responsibilities on the day(s) of the course? Answer. o The typical course day handouts include Plan of the day Performance Checklist Performance Evaluation Test Part I & II (Pre & Post course) 5

6 Written Evaluation Part I & II (Pre and Post course) Posters Evaluation forms (Feedback Forms) to be filled by participants o Checklists on the day of the Course Check audiovisual arrangements half hour before the course begins Mark attendance of all course attendees Give hand outs Administer pre test evaluation COURSE DOCUMENTATION The IAP NRP FGM project aims to develop an efficient, cost effective and sustainable system for ongoing training and monitoring of Basic Newborn Care and Resuscitation Program in India. It is important that the program fulfils the need for large scale training and periodic re-training and continuous evaluation with emphasis on quality control. The program will create a sustainable network through dedicated Regional trainers and District Instructors. IAP will issue Certificate/Cards valid for two years to various levels of Instructors and providers, and arrange for revalidation every two years. More than 2 lac health professionals will be trained in Basic Newborn Care and Resuscitation Program under NRP FGM Project in the next 3 years. Documentation and data management of courses conducted and records of the validity of various Instructors and Providers cards are very important for the success of this program and for research, which will help in fine tuning program strategy in the coming years. A data management system is being developed to support the program. A dedicated person will be employed to work as NRP FGM coordinator at IAP central office for supervising Basic Newborn Care and Resuscitation Program coordination at various levels, and for data entry. 6

7 This chapter gives a step by step approach for documentation requirements and procedures for NRP FGM Basic Newborn Care and Resuscitation Program. o A NRP FGM Basic Newborn Care and Resuscitation Program course is organized by a designated Course-Coordinator (IAP Branch President or his nominee, identified by the Regional Trainer/ State Academic Coordinator). The Course coordinator may not necessarily be a trained FGM Instructor. o The course will be conducted by a Lead Instructor and Assisting Instructors identified by the Regional Trainer/ State Academic Coordinator. Instructor level qualifications for various courses are detailed elsewhere in this document. o The Lead Instructor is responsible for reporting the course by sending Course-Roster to central IAP office. The Lead Instructor must submit completed NRP FGM Basic Newborn Care and Resuscitation Program Course-Rosters to IAP central office at the earliest after completion of the program. The remaining amount will only be reimbursed from central IAP Office when all the original bills are accompanied by the dully filled course-roster. However, the course completion certificates shall be awarded after the course completion and they will be signed received from Central IAP. o Each form should include the names of only those candidates who were taught at the same course level (Provider, Instructor District or Regional Trainer). If more than one course level is taught on the same day, separate NRP FGM Course-Rosters must be submitted. FAQs ON COURSE DOCUMENTATION Why it is important to submit the Course-Roster Form? Answer. If the lead Instructor does not submit the Course Roster, the NRP FGM staff at central IAP office cannot verify participation by instructors or participants. If a course participant calls the IAP office to verify his or her provider status, no such record will exist. 7

8 Why do I need to write participant s address and email address? Answer. It is important to maintain data and also to send NRP Updates periodically throughout the year and additional mailings with information about NRP FGM. When do the participants get course completion certificate? Answer. Immediately after the course the certificate of successful completion should be awarded to those who scores 84% and above those do not score should undergo remediation, and failing which, they should be asked to repeat the course at next opportunity. What is the responsibility of a Lead Instructor / Course Coordinator for record keeping and how long after course completion? Answer The Lead instructor needs to maintain the following record for at least 3 years after the date of course A completed Course Roster A copy of the NRP FGM Master Recording Sheet. This sheet lists the name of each course participants along with scores from performance and written evaluations and Mega code. The course coordinator needs to maintain the following record for at least 1 year (Preferably 3 years) after the date of course A signed attendance sheet listing all participants Individual Answer/Recording Sheet of each participant of written evaluation and Mega code. This will help if there are any questions in future. How will the IAP NRP FGM staff maintain records? 8

9 Answer Each Course Roster submitted will be kept in an electronic file with a copy to core committee for at least 3 years from the last course completion date on the form. An online data entry software will soon be developed allowing course coordinators to enter date directly on IAP NRP FGM website An Instructor FGM ID will be assigned to all who have completed Instructor Courses. Annexures 1. Road Map 2. Course Roster Form 3. Mark sheet 4. Feedback form 9

10 ROAD MAP IAP launched the NRP First Golden Minute Project in 2009. The First Golden Minute Project has two components: Basic Newborn Care and Resuscitation Program and Advanced NRP. This document contains guidelines for roll out of Basic Newborn Care and Resuscitation Program in the private sector. Johnson and Johnson India Ltd have provided academic grant to train 2, 00,000 health care providers in the private sector in the forthcoming 3 years. The Government of India has launched Basic Newborn Care and Resuscitation Program under NSSK (Navjat Shishu Suraksha Karyakram) to reduce neonatal mortality. IAP is a nodal agency for implementation of NSSK in the Government sector. IAP has adopted the NSSK Training manual for use in private sector with permission of Government of India, MOHFW. The Basic Newborn Care and Resuscitation Program will be rolled out in the coming years as per the road map detailed below A. Calculating the training load and the basic structure 1. The number of Districts in a given State, in which the program is intended to be begun, will be counted (N) 2. Four District Instructors will be created in each District. Therefore the total number of DIs in each state will be 4 x N. 3. One District Instructor TOT course will train 40 prospective delegates. Therefore the total number of TOTs required in a state would be 4 x N / 40 or N / 10. 4. The District Instructors will conduct NRP Provider Courses in their respective Districts for all Private Sector Pediatricians, Obstetricians, Anesthetists, and other health professionals responsible for attending labor calls. These will be labeled as District Provider Courses. 5. One Paramedical staff from each private maternity-service-provider center will also be trained; therefore their number should add to the number of healthcare providers to be trained. 6. District Instructors should preferably be Pediatricians and IAP members but Obstetricians and members of FOGSI can be also trained as District Instructors. 10

11 Example of MP State 1. Number of Districts in Madhya Pradesh = 50 2. Total number of District Instructors to be trained = 4 x 50 = 200 3. Total number of TOTs required = 200 / 40 = 5 (Gwalior, Bhopal, Indore, Jabalpur and Rewa) B. Selection of Participants 1. Participants for Training of Trainers i.e. Potential District Instructors should be selected by State academic coordinator in consultation with the Local IAP President & Secretary they should preferably be Paediatricians and IAP members. 2. The selection should be made only after considering the merits of candidates (teaching skills, academic understanding and willingness to propagate the skills of Basic Newborn Care) 3. The final list has to be sent for approval to steering committee of IAP NRP FGM. 4. The Participants will have to give an undertaking that they will promote and propagate the mission of NRP FGM. C. Release of funds for courses 1. The finances for these courses will be released through Central IAP 2. Finances for the Training of Trainers (ToT) workshop will be rendered by Central IAP to the organizing branch as per recommendations of State Academic and Zonal Coordinators 3. For provider courses the organizing branch shall submit the THREE MONTH program with dates to the State academic and Zonal Coordinators. Then they will be entitled for the release of advance payment (about 80 % of the budgeted amount) the final payment will be made ONLY after submission of actual bills, and the completely filled course roaster. D. Course Schedule 1. The Training of Trainers (ToT) courses will be held on two consecutive days as per the course timetable and the course manual. 11

12 2. The Provider course will also be held on two days ( preferably consecutive days; however, if the participants or the local IAP organizers feel they can divide the course between two consecutive Sundays, that will be acceptable) E. Guidelines for Training of Trainers (TOT) Program 1. It should be a two day program of 18 hours duration. 2. Many District instructors were trained in Basic Newborn Resuscitation in last two years. Similarly regional trainers were trained at Bangalore Training of Trainers during Pedicon 2009. New program includes other components of newborn care and there are many changes in resuscitation component also including algorithm which is adopted from NSSK Training manual. To be eligible for becoming Trainers in FGM Basic Newborn Care and Resuscitation Program, all these trainers have to undergo a reorientation Program of 15 hrs duration over two days or they can attend Training of Trainers of 18 hrs over two days. This is essential so that they may become well versed with the present status of and style of conducting workshop using NSSK manual. If the number of DI is less in some state than such reorientation course can be done jointly for 2-3 states. 3. Training of Trainers for District Instructors for Pvt Sector will be two day course as per the set roster of NSSK manual. The city will be decided by the State Academic coordinators of NRP FGM in consultation with State IAP President +Secretary and local IAP will coordinate it as per the mentioned guidelines under central IAP. 4. Participants will be invited from nearby Districts of the city where Training of Trainers is being organized. After getting the approved list from Steering Comm. 5. Five National/Regional Trainers will conduct each of such Training of Trainers; this Training of Trainers will be coordinated by state academic coordinators. They will plan the course and seek permission from Zonal coordinator. 6. The lead instructor (appointed by Zonal coordinator) will decide the faculty in consultation with zonal coordinator and will be responsible for smooth conduction of all stations and time management for each lesson and skill. 7. The Local IAP office bearers will be responsible for arranging all logistics. They should ensure that all the participants receive the manual at least a fortnight before the scheduled date of course and they MUST read it before the course. 12

13 8. The training kits should remain with the IAP office bearers, and they should ONLY be used for training purposes. 9. From bigger cities more numbers can be selected but the Total number of DIs of the state should remain constant (i.e. four per District). 10. One set of resuscitation kit will be given to each participant (who will be designated as District Instructor), but they should keep them with local IAP office and should use them only for training. 11. District Instructors will conduct District Provider courses of Basic Newborn care and resuscitation in respective Districts. F. Guidelines for District Provider Courses 1. The objective of Provider course is to train all Pediatricians, Obstetricians and one paramedical staff from each Nursing Home. 2. The delegate load can be calculated through - Total No of Pediatricians + Total No of Obstetricians + 1 Paramedic from each maternity service provider setup = Total number of participants in a particular District. 3. Total Number of Participants divided by 32 will give the Total number of provider courses needed. Example of MP State o Pediatricians 1500 o Obstetricians 2500 o Nursing Homes + Pvt Hospitals 500 o Total No. of Doctors - 4000 @ 32/course = 125 o Total no paramedics 500 @32/course = 16 o Total Number of courses - 141 4. The Designated District Instructors shall be responsible for conducting District Provider courses 5. These courses shall be of two days strictly restricting to the roster of present NSSK teaching. However as mentioned earlier if the participants or local organizers decide otherwise, it can be stretched to consecutive Sundays. 6. Ratio of instructor to participant shall be maximum 1:8. 13

14 7. The budget for these courses will be as mentioned, and will be released as per the set frame explained earlier. 8. State academic coordinators shall supervise these course and if a city has a National instructor than he/she must be involved as an expert and must be given due acknowledgement. The sanctity must be maintained in every District Provider course and all components MUST be accomplished sincerely. 9. District Provider Courses will be organized at District places and shall be programmed as per local traditions Total of 18 hours should be devoted for one course (can be stretched to two consecutive Sundays). 10. All the stationary (filled pre & post test (written and performance evaluation) forms with final marks tally with course roster MUST be sent to State academic coordinator of state with a copy marked to COIAP and national coordinator. G. Feedback Form Every course will have feedback form to be sincerely filled by Participants. It will be a feedback about instructors and also about the arrangements of the course. H. Maximum Approved Budget for District TOT Courses State level training of district instructors of two days duration Total cost in INR Detail unit cost no. no. of days TA for National faculty 10000 2 1 20000 Per Diem for National faculty 2000 2 2 8000 Stay for national faculty 2500 2 2 10,000 TA for regional faculty 2500 3 1 7,500 Per Diem for Regional faculty 1500 3 2 9,000 Stay for regional faculty 2500 3 1 7,500 TA for out station participants 1200 40 1 48,000 Shared Stay for outstation participants 1000 40 1 40,000 Food expenses 500 50 2 50,000 Audio visual charges 2,500 1 2 5,000 Stationery 1000 1 1 1,000 Contingency 2,000 1 1 2,000 Please note that the per diem for National faculty for one day (if more than half day is wasted in travel) as Rs 1000/- has to be approved cost of 1 training 40 trainings grand total 208,000 8,32,0000 2,08,000 14

15 I. Maximum approved budget for District Provider Courses (32 Participants per training) District level training of Doctors, Nurses of one- day duration Detail unit cost no. no. of days Total cost in INR Per Diem for District facilitator 750 4 2 6,000 Food expenses 200 40 2 16,000 Audio visual charges 1,000 1 2 2,000 Stationery 500 1 1 500 Contingency 1,000 1 1 1,000 25,500 Grand total for 1 District training for 2 days 50,000 15

16 SAMPLE COURSE ROSTER FORM Indian Academy of Pediatrics Neonatal Resuscitation Program First Golden Minute Project, Basic Newborn care and resuscitation Program Course Roster form A. Course Information Date of course completion.. Type/Level of course taught : Provider Basic [ ] District Instructor [ ] Course Location.. Total number of candidates in the course Total number who successfully completed the course Course Coordinator name and contact details - B. Lead Instructor Information Lead Instructor NRP ID Name.. Lead Instructor s NRP level (Check one) National / Regional Trainer [ ] District Instructor [ ] Lead Instructor s contact details.. 16

17 C. Information of Co-instructors (*RT = Regional Trainer; DI = District Instructor Name of the Assisting Instructors 1 Instructor level RT / DI* NRP ID Contact Address Email Address 2 3 4 5 D. Candidates Information S. no 1 Name Qualification /Vocation IAP Member? Yes / No. Number? Full Postal address Phone no and Email Place of Work 2 3 4 We verify that the persons listed on the roster have successfully completed the national cognitive and performance examinations for the IAP NRP FGM in accordance with the standards of IAP. Course Coordinator Lead Instructor Date - (Please mail this Roster form by email to NRP FGM coordinator at centraloffice@iapindia.org or mail to Indian Academy of Pediatrics, Kailas Darshan, Nana Chowk, Mumbai 400020; Incomplete Rosters will be returned unprocessed; Copy email to State academic co-coordinator / Zonal coordinator) 17

18 3. SAMPLE MARKS RECORDING SHEET S.NO NAME PE 1 PE1 PE 2 PE 2 WE 1 WE 1 WE 2 WE 2 PRE POST PRE POST PRE POST PRE POST 1 2 3 4 4. FEEDBACK FORM ON TOT INSTRUCTORS Name of the Trainer Knowledge Facilitation Skill Body Language Attention to the participants 18

19 5. FEEDBACK ON LOGISTICS Accommodation Average Good Very Good Excellent Food Average Good Very Good Excellent Venue Average Good Very Good Excellent Training materials Average Good Very Good Excellent Teaching Aids Average Good Very Good Excellent Environment Average Good Very Good Excellent Overall impression Average Good Very Good Excellent Comments and suggestions 1) 2) 3) 19