41 research outputs found
Why clinical audit is important in midwifery: experiences from Kenya
No full textBackground: Clinical are an assessment of working practice against an agreed standard, with the intention of identifying areas for improvement and recommending interventions to address them ( Mancey-Jones and Brugha, 1997 ). However, audits are not widely used in low or middle income countries. LAMRN set out to strengthen the capacity of midwives in Kenya to carry out clinical audits Aim: To describe the development of an audit project in Kenyatta National Hospital and Pumwani Maternity Hospital. Methods: Midwives were asked to identify auditable areas from clinical practice, which were ranked in order of priority. The problem with the highest score following ranking was chosen for audit and discussed with the management and clinical teams in each hospital. An audit protocol was then designed and an audit completed. This article highlights how the audit was undertaken; results are due to follow. Findings: Midwives in both hospitals agreed to audit postpartum haemorrhage and developed an audit proposal. This outlined the audit objectives, critical standards for the management of postpartum haemorrhage, data collection methods, timelines, roles of each team member and expected outcomes. Conclusions: Using a systematic approach, midwives in Kenya were able to identify an auditable problem, set clear objectives and standards to conduct the audit and develop methods to carry out the audit successfully. </jats:sec
Evaluating the documentation of vital signs following implementation of a new comprehensive newborn monitoring chart in 19 hospitals in Kenya: A time series analysis.
No full textMulti-professional teams care for sick newborns, but nurses are the primary caregivers, making nursing care documentation essential for delivering high-quality care, fostering teamwork, and improving patient outcomes. We report on an evaluation of vital signs documentation following implementation of the comprehensive newborn monitoring chart using interrupted time series analysis and a review of filled charts. We collected post-admission vital signs (Temperature (T), Pulse (P), Respiratory Rate (R) and Oxygen Saturation (S)) documentation frequencies of 43,719 newborns with a length of stay > 48 hours from 19 public hospitals in Kenya between September 2019 and October 2021. The primary outcome was an ordinal categorical variable (no monitoring, monitoring 1 to 3 times, 4 to 7 times and 8 or more times) based on the number of complete sets of TPRS. Descriptive analyses explored documentation of at least one T, P, R and S. The percentage of patients in the no-monitoring category decreased from 68.5% to 43.5% in the post-intervention period for TPRS monitoring. The intervention increased the odds of being in a higher TPRS monitoring category by 4.8 times (p<0.001) and increased the odds of higher monitoring frequency for each vital sign, with S recording the highest odds. Sicker babies were likely to have vital signs documented in a higher monitoring category and being in the NEST360 program increased the odds of frequent vital signs documentation. However, by the end of the intervention period, nearly half of the newborns did not have a single full set of TPRS documented and there was heterogenous hospital performance. A review of 84 charts showed variable documentation, with only one chart being completed as designed. Vital signs documentation fell below standards despite increased documentation odds. More sustained interventions are required to realise the benefits of the chart and hospital-specific performance data may help customise interventions
First do no harm: practitioners’ ability to ‘diagnose’ system weaknesses and improve safety is a critical initial step in improving care quality
No full textHealthcare systems across the world and especially those in low-resource settings (LRS) are under pressure and one of the first priorities must be to prevent any harm done while trying to deliver care. Health care workers, especially department leaders, need the diagnostic abilities to identify local safety concerns and design actions that benefit their patients. We draw on concepts from the safety sciences that are less well-known than mainstream quality improvement techniques in LRS. We use these to illustrate how to analyse the complex interactions between resources and tools, the organisation of tasks and the norms that may govern behaviours, together with the strengths and vulnerabilities of systems. All interact to influence care and outcomes. To employ these techniques leaders will need to focus on the best attainable standards of care, build trust and shift away from the blame culture that undermines improvement. Health worker education should include development of the technical and relational skills needed to perform these system diagnostic roles. Some safety challenges need leadership from professional associations to provide important resources, peer support and mentorship to sustain safety work
Evaluating the documentation of vital signs following implementation of a new comprehensive newborn monitoring chart in 19 hospitals in Kenya: A time series analysis
No full textPercentage of patients’ TPRS monitored in each category over time (month 0 –intervention start).
No full textPercentage of patients’ TPRS monitored in each category over time (month 0 –intervention start).</p
Hospital characteristics.
No full textMulti-professional teams care for sick newborns, but nurses are the primary caregivers, making nursing care documentation essential for delivering high-quality care, fostering teamwork, and improving patient outcomes. We report on an evaluation of vital signs documentation following implementation of the comprehensive newborn monitoring chart using interrupted time series analysis and a review of filled charts. We collected post-admission vital signs (Temperature (T), Pulse (P), Respiratory Rate (R) and Oxygen Saturation (S)) documentation frequencies of 43,719 newborns with a length of stay > 48 hours from 19 public hospitals in Kenya between September 2019 and October 2021. The primary outcome was an ordinal categorical variable (no monitoring, monitoring 1 to 3 times, 4 to 7 times and 8 or more times) based on the number of complete sets of TPRS. Descriptive analyses explored documentation of at least one T, P, R and S. The percentage of patients in the no-monitoring category decreased from 68.5% to 43.5% in the post-intervention period for TPRS monitoring. The intervention increased the odds of being in a higher TPRS monitoring category by 4.8 times (p</div
PLOS questionnaire on inclusivity in global research.
No full textPLOS questionnaire on inclusivity in global research.</p
STROBE statement—checklist of items that should be included in reports of observational studies.
No full textSTROBE statement—checklist of items that should be included in reports of observational studies.</p
Additional file 1 of Using a human-centred design approach to develop a comprehensive newborn monitoring chart for inpatient care in Kenya
No full textAdditional file 1: Appendix 1.. Information sheet
Additional file 3 of Using a human-centred design approach to develop a comprehensive newborn monitoring chart for inpatient care in Kenya
No full textAdditional file 3: Appendix 3. Comprehensive Newborn Monitoring Chart
