Evaluation of an audit and feedback intervention to reduce gentamicin prescription errors in newborn treatment (ReGENT) in neonatal inpatient care in Kenya: a controlled interrupted time series study protocol

Tuti, Timothy; Aluvaala, Jalemba; Malla, Lucas; Irimu, Grace; Mbevi, George; Wainaina, John; Mumelo, Livingstone; Wairoto, Kefa; Mochache, Dolphine; Hagel, Christiane; Maina, Michuki; English, Mike

doi:10.1186/s13012-022-01203-w

Cited by 2 publications

(2 citation statements)

References 55 publications

(95 reference statements)

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“…[32] For example, more active feedback might be needed for more complex tasks such as to promote accurate prescribing. Further elaborations might explicitly address (1) capacity limitations of CIN-N hospitals and clinical teams to produce the improvements required, (2) lessons learned about the identity and culture of each individual CIN-N hospital and site specific barriers to change (3) specific use of behavioural thinking that directly supports positive clinical behaviours by ensuring feedback is actionable, controllable and timely [39, 52].…”

Section: Discussionmentioning

confidence: 99%

Improving the quality of in-patient neonatal routine data as a pre-requisite for monitoring and improving quality of care at scale: A multi-site retrospective cohort study in Kenyan hospitals

Tuti

Aluvaala

Chelangat

et al. 2022

Preprint

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Objectives The objectives of this study were to (1) determine if membership of a clinical information network (CIN) was associated with an improvement in the quality of documentation of in-patient neonatal care provided over time, and (2) characterise accuracy of prescribing for basic treatments provided to neonatal in-patients if data are adequate. Design and Settings This was a retrospective cohort study involving all children aged <=28 days admitted to New-Born Units (NBUs) between January 2018 and December 2021 in 20 government hospitals with an interquartile range of annual NBU inpatient admissions between 550 and 1640 in Kenya. These hospitals participated in routine audit and feedback processes on quality of documentation and care over the study period. Outcomes The study’s outcomes were the number of patients as a proportion of all eligible patients with (1) complete domain-specific documentation scores, and (2) accurate domain-specific treatment prescription scores at admission. Findings 80060 NBU admissions were eligible for inclusion. Upon joining the CIN, documentation scores in the monitoring (vital signs) , other physical examination and bedside testing , discharge information , and maternal history domains demonstrated a statistically significant month-to-month relative improvement in number of patients with complete documentation of 7.6%, 2.9%, 2.4%, and 2.0% respectively. There was also statistically significant month-to-month improvement in prescribing accuracy after joining the CIN of 2.8% and 1.4% for feeds and fluids but not for Antibiotic prescriptions. Findings suggest that much of the variation observed is due to hospital-level factors. Conclusions It is possible to introduce tools that capture important clinical data at least 80% of the time in routine African hospital settings but analyses of such data will need to account for missingness using appropriate statistical techniques. These data allow trends in performance to be explored and could support better impact evaluation, performance benchmarking, exploration of links between health system inputs and outcomes and scrutiny of variation in quality and outcomes of hospital care.

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Section: Discussionmentioning

confidence: 99%

Improving the quality of in-patient neonatal routine data as a pre-requisite for monitoring and improving quality of care at scale: A multi-site retrospective cohort study in Kenyan hospitals

Tuti

Aluvaala

Chelangat

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…For example, more active feedback might be needed for more complex tasks such as to promote accurate prescribing. Further elaborations might explicitly address (1) capacity limitations of CIN-N hospitals and clinical teams to produce the improvements required, (2) lessons learned about the identity and culture of each individual CIN-N hospital and site specific barriers to change (3) specific use of behavioural thinking that directly supports positive clinical behaviours by ensuring feedback is actionable, controllable and timely [40,52].…”

Section: Implications Of Findingsmentioning

confidence: 99%

Improving in-patient neonatal data quality as a pre-requisite for monitoring and improving quality of care at scale: A multisite retrospective cohort study in Kenya

Tuti

Aluvaala²,

Chelangat³

et al. 2022

PLOS Glob Public Health

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The objectives of this study were to (1)explore the quality of clinical data generated from hospitals providing in-patient neonatal care participating in a clinical information network (CIN) and whether data improved over time, and if data are adequate, (2)characterise accuracy of prescribing for basic treatments provided to neonatal in-patients over time. This was a retrospective cohort study involving neonates ≤28 days admitted between January 2018 and December 2021 in 20 government hospitals with an interquartile range of annual neonatal inpatient admissions between 550 and 1640 in Kenya. These hospitals participated in routine audit and feedback processes on quality of documentation and care over the study period. The study’s outcomes were the number of patients as a proportion of all eligible patients over time with (1)complete domain-specific documentation scores, and (2)accurate domain-specific treatment prescription scores at admission, reported as incidence rate ratios. 80,060 neonatal admissions were eligible for inclusion. Upon joining CIN, documentation scores in the monitoring, other physical examination and bedside testing, discharge information, and maternal history domains demonstrated a statistically significant month-to-month relative improvement in number of patients with complete documentation of 7.6%, 2.9%, 2.4%, and 2.0% respectively. There was also statistically significant month-to-month improvement in prescribing accuracy after joining the CIN of 2.8% and 1.4% for feeds and fluids but not for Antibiotic prescriptions. Findings suggest that much of the variation observed is due to hospital-level factors. It is possible to introduce tools that capture important clinical data at least 80% of the time in routine African hospital settings but analyses of such data will need to account for missingness using appropriate statistical techniques. These data allow exploration of trends in performance and could support better impact evaluation, exploration of links between health system inputs and outcomes and scrutiny of variation in quality and outcomes of hospital care.

show abstract

Evaluation of an audit and feedback intervention to reduce gentamicin prescription errors in newborn treatment (ReGENT) in neonatal inpatient care in Kenya: a controlled interrupted time series study protocol

Cited by 2 publications

References 55 publications

Improving the quality of in-patient neonatal routine data as a pre-requisite for monitoring and improving quality of care at scale: A multi-site retrospective cohort study in Kenyan hospitals

Improving the quality of in-patient neonatal routine data as a pre-requisite for monitoring and improving quality of care at scale: A multi-site retrospective cohort study in Kenyan hospitals

Improving in-patient neonatal data quality as a pre-requisite for monitoring and improving quality of care at scale: A multisite retrospective cohort study in Kenya

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