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.