Maina Michuki, Aluvaala Jalemba, Mwaniki Paul, Tosas-Auguet Olga, Mutinda Catherine, Maina Beth, Schultsz Constance, English Mike
Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
Department of Paediatrics and Child Health, University of Nairobi, Nairobi Kenya.
BMJ Glob Health. 2018 Sep 19;3(5):e001027. doi: 10.1136/bmjgh-2018-001027. eCollection 2018.
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.
已确定了可在医院有效实施的降低新生儿死亡的基本干预措施。改善信息系统可能有助于大规模地对这些干预措施的实施情况和结果进行常规监测。我们采用审核与反馈（A&F）循环，并结合使用标准化新生儿入院记录（NAR）表格，来探索创建一个通用的住院新生儿数据平台的潜力，并说明其在监测处方准确性方面的潜力。从2014年1月至2016年11月的3年时间里，在肯尼亚的一个高容量新生儿病房引入了修订后的NAR，并召开了13次审核与反馈会议。在引入修订后的NAR和审核与反馈之前的15个月以及审核与反馈期间的3年里，从病历中提取数据。我们计算了每位患者在总推荐记录项目中已记录项目的百分比以及随时间推移计算出的趋势。还对庆大霉素的处方准确性进行了长期跟踪。在审核与反馈前和审核与反馈后阶段，分别对827名和7336名患者的记录进行了检查。总体而言，记录分数有所提高。孕周记录从2014年的<15%提高到2016年的>75%。对于包括体温在内的五项推荐项目，记录率仍<50%。16.7%（n =1367；95%CI 15.9至17.6）的入院婴儿被诊断为需要抗生素治疗的新生儿败血症。在这一组中，2013年体重低于2千克的婴儿庆大霉素给药准确性从60%（95%CI 36.1至80.1）提高到2016年的83%（95%CI 69.2至92.3）。我们报告称，使用与相对基本的电子数据收集工具及审核与反馈循环相关联的标准化新生儿记录，可以改善新生儿病房的常规数据收集。这对于识别潜在的护理差距和跟踪结果以提高护理质量可能是有用的。
