Using a common data platform to facilitate audit and feedback on the quality of hospital care provided to sick newborns in Kenya

Abstract

Essential interventions to reduce neonatal deaths that can be effectively delivered in hospitals have been identified. Improving information systems may support routine monitoring of the delivery of these interventions and outcomes at scale. We used cycles of audit and feedback (A&F) coupled with the use of a standardised newborn admission record (NAR) form to explore the potential for creating a common inpatient neonatal data platform and illustrate its potential for monitoring prescribing accuracy. Revised NARs were introduced in a high volume, neonatal unit in Kenya together with 13 A&F meetings over a period of 3 years from January 2014 to November 2016. Data were abstracted from medical records for 15 months before introduction of the revised NAR and A&F and during the 3 years of A&F. We calculated, for each patient, the percentage of documented items from among the total recommended for documentation and trends calculated over time. Gentamicin prescribing accuracy was also tracked over time. Records were examined for 827 and 7336 patients in the pre-A&F and post-A&F periods, respectively. Documentation scores improved overall. Documentation of gestational age improved from <15% in 2014 to >75% in 2016. For five recommended items, including temperature, documentation remained <50%. 16.7% (n=1367; 95% CI 15.9 to 17.6) of the admitted babies had a diagnosis of neonatal sepsis needing antibiotic treatment. In this group, dosing accuracy of gentamicin improved over time for those under 2 kg from 60% (95%36.1 to 80.1) in 2013 to 83% (95% CI 69.2 to 92.3) in 2016. We report that it is possible to improve routine data collection in neonatal units using a standardised neonatal record linked to relatively basic electronic data collection tools and cycles of A&F. This can be useful in identifying potential gaps in care and tracking outcomes with an aim of improving the quality of care.

Competing risk survival analysis of time to in-hospital death or discharge in a large urban neonatal unit in Kenya

“…This was a retrospective cohort study using a routine inpatient data set from a large urban neonatal unit 30 . Study participants were followed up from the time of admission to the unit to time of exit (defined as either death, discharge or referral).…”

“…The study site was the neonatal unit in the largest public-sector maternity hospital in Nairobi, Kenya. The unit admits approximately 4500 neonates annually and on any given day has about 60 neonates cared for by 2-3 nurses per shift 30 . Total medical staffing providing 24 hour 7 days a week care includes four Paediatricians, six Medical Officers and four Clinical Officers 30 .…”

“…The unit admits approximately 4500 neonates annually and on any given day has about 60 neonates cared for by 2-3 nurses per shift 30 . Total medical staffing providing 24 hour 7 days a week care includes four Paediatricians, six Medical Officers and four Clinical Officers 30 . The admitted neonates receive essential in-patient neonatal care with the most advanced intervention being limited capacity to provide continuous positive airway pressure (CPAP) therapy.…”

Effective coverage and budget implications of skill-mix change to improve neonatal nursing care: an explorative simulation study in Kenya

“…For each category of care, the model input parameters included the number of newborns, admission rate, rate of newborns surviving the first day of admission and length of hospital stay conditional on surviving the first admission day (this was done to account for the high mortality rate on day 1 and to decrease the skewness in hospital days). These parameters as well as the transition of newborns from the most severe to the least severe category of care were informed by data from one of the four public hospitals in Nairobi for which high-quality data exist and confirmed by the experts during the workshops 26…”

What topics should we teach the parents of admitted neonates in the newborn care unit in the resource-limited setting - a Delphi study

“…In order to achieve this care facilities in low-income countries (LICs) should deliver proven, effective interventions to substantially reduce newborn mortality [5]. Monitoring and evaluation of interventions and care programs are vital to identify effective interventions [6]. The Rwandan Ministry of Health includes a Neonatal Working Group to implement such change nationally and data monitoring is undertaken using the Integrated Health Management Information System (HMIS) [7].…”