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.

Keywords: audit and feedback; neonatal care; quality of care.

Figure 1

Trends in completeness of documentation of various parts of the newborn admission record over 3 years. The black shade around the trends is the 95% CIs around the estimates. The dotted line represents the introduction of prospective data collection in April 2014.

Figure 2

Proportion of documentation of gestational age among hospitalised neonates in 6-month intervals with 95% CIs around the estimates. The dotted line represents the introduction of prospective data collection.

Figure 3

Charts showing dosing trends of gentamicin over time in 6-month intervals from January 2013 for those under 2 kg (Upper panel) or over 2 kg (lower panel). The grey shade indicates the 95% CIs around the estimates. The dotted line represents the introduction of prospective data collection.