Abstract
Multi-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.
Original language | English |
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Article number | e0002440 |
Pages (from-to) | 1-17 |
Number of pages | 17 |
Journal | PLOS Global Public Health |
Volume | 3 |
Issue number | 11 |
Early online date | 1 Nov 2023 |
DOIs | |
Publication status | Published - Nov 2023 |
Bibliographical note
Publisher Copyright:© 2023 Muinga et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding
NM was supported through the DELTAS Africa Initiative [DEL-15-003]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)\u2019s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa\u2019s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust [107769/Z/10/Z] and the UK government. Funds from a Wellcome Trust Senior Clinical Research Fellowship (#207522) awarded to Professor Mike English supported this work together with a core grant awarded to the KEMRI-Wellcome Trust Research Programme (#092654) and a grant to the NEST program from the John D. and Catherine T. MacArthur Foundation, the Bill & Melinda Gates Foundation, ELMA Philanthropies, and The Children\u2019s Investment Fund Foundation UK under agreements to William Marsh Rice University with a sub-agreement through the University of Oxford Centre for Tropical Medicine and Global Health. The views expressed in this publication are those of the author(s) and not necessarily those of AAS, NEPAD Agency, Wellcome Trust, the UK government or other funders. The funders had no role in study design, data collection and analysis, the decision to publish, or preparation of the manuscript.
Funders | Funder number |
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ELMA Philanthropies | |
NEPAD Agency | |
African Academy of Sciences | |
John D. and Catherine T. MacArthur Foundation | |
New Partnership for Africa's Development | |
Children's Investment Fund Foundation | |
Bill and Melinda Gates Foundation | |
Rice University | |
Wellcome Trust | 107769/Z/10/Z |
Government of the United Kingdom | 207522 |
KEMRI-Wellcome Trust Research Programme | 092654 |