Quality and reliability of vaccination documentation in the routine childhood immunization program in Burkina Faso: Results from a cross-sectional survey

INTRODUCTION

Accurate and timely vaccination data are important to the Expanded Program on Immunization (EPI) to assess individual vaccination status and to monitor performance and vaccine coverage (VC). Since 2013, Burkina Faso introduced several new vaccines into the routine childhood immunization schedule. However, sustained efforts for a timely update and alignment of immunization home-based (HBRs) and health facility-based records (FBRs) with the evolving schedule were not implemented.

METHODS

In 2016-17, we conducted a 6-week cross-sectional survey in 30 health facilities (HFs) across 10 health districts (HDs), targeting children aged < 24 months and their caregivers. Data collected included sociodemographics, availability of vaccination recording fields in HBRs, and vaccination dates. We evaluated the characteristics, completion patterns, and concordance of HBRs and FBRs to determine their reliability as data sources in estimating VC. A standard HBR was defined as one that had recording fields for all recommended 17 vaccine doses of the schedule, and discordance between HBR and FBR as having different vaccination dates recorded, or vaccination information missing in one of the records. We computed proportions and concordance statistics, and used logistic regression to explore predictors of discordance.

RESULTS

We recruited 619 children, including 74% (n = 458) aged 0-11 months. Half (50.6%) of HBRs were non-standard. About two-thirds (64.6%) of children were concerned with discordant information. Compared to HBRs, FBRs were generally associated with low negative predictive values (median: 0.41; IQR: 0.16-0.70). Multivariate logistic regression model showed that standard HBR was protectively associated with discordant information (OR = 0.46, 95% CI: 0.26-0.81, p = 0.010).

CONCLUSION

We documented a lack of standardization of HBRs and frequent information discordance with FBRs. There is a pressing need to update and standardize vaccination recording tools and ensure their continuous availability in HFs to improve data quality in Burkina Faso.

Establishing extracorporeal membrane oxygenation team increased number of patients and improved data recording

Background

For patients treated with extracorporeal membrane oxygenation (ECMO), employing a well-coordinated, multidisciplinary team specializing in ECMO has reportedly been effective in delivering better clinical outcomes. This study aims to assess the impact of establishing such a specialized team for patients treated with ECMO.

Method

This retrospective cohort study was performed at a tertiary-care hospital in Japan. We reviewed medical records of all consecutive patients treated with ECMO during October 2010–September 2016. The results obtained in pre-ECMO team cases (PRE group; October 2011–September 2012) and post-ECMO team cases (POST group; October 2014–September 2015) were compared.

Results

The results obtained in pre-ECMO team cases (PRE group; October 2011–September 2012) and post-ECMO team cases (POST group; October 2014–September 2015) were compared. During the study period, 177 patients were treated with ECMO. Before the introduction of ECMO team, an average of 22.7 patients underwent ECMO treatment per year; after establishing ECMO team, this number increased to 36.3 patients per year. ECMO was applied mainly to cardiac arrest patients 52/69 (75%). The PRE (n = 27) and POST (n = 42) groups did not differ with regard to the survival rate to hospital discharge, ECMO duration, ventilator days, and length of hospital stay. However, PaO₂ and positive end-expiratory pressure were significantly higher in the POST group at 6 h after ECMO initiation than those in the PRE group [367 (186–490) vs. 239 (113–430) mmHg, p = 0.047 and 8 (5–10) vs. 7 (5–8) cmH₂O, p = 0.01, respectively]. In addition, data recording the detailed time points of ECMO initiation was conducted in significantly more cases in the POST group (28/126 (22%) than in the PRE group (6/81 (7%); p = 0.01).

Conclusions

Following the establishment of an ECMO team, the survival rate of patients treated with ECMO, ECMO duration, and length of hospital stay were not improved. However, the number of ECMO cases increased and the recording of clinical data was improved.

Nurse prescribers' experiences of recording prescribing data to the Minimum Data Set in Ireland

This study aimed to investigate and enhance understanding of nurse prescribers' experiences of working with the Irish national data gathering system for nurse prescribing: the Minimum Data Set (MDS) in Irish clinical practice. A phenomenological research design was used, collecting data via semi-structured interviews using a purposive sample of practising nurse prescribers. The study identified three recurrent themes: communication, workload/time, and attitudes. The MDS produces only standard national reports (lists) on nurse/midwife prescribing that cannot be utilised efficiently to inform practice or understand health service needs. Nurses have reacted to this situation and evaluate the MDS in the context of their clinical setting, identifying conflicting demands and expectations and an increased workload as factors that correlated negatively with the process of collecting nurse prescribing data. Consultation and evaluation is required, particularly to analyse the nurse prescribers' views of collecting data and working with the MDS in the context of the major adjustments that the Irish health service has experienced over the past 6 years.

Improved Data Quality by Pen Computer-Assisted Emergency Room Data Recording Following Major Trauma in the Military Setting

INTRODUCTION

The characteristics of combat injuries differ from those of injuries encountered in civilian practice. Capturing detailed combat casualty data is therefore of importance. Experts classify the data sources for combat injuries as "inadequate" and request a better and more accurate record keeping. Within the civilian setting it has been shown that "point of care - computer-assisted" recording techniques are superior to conventional "paper-based" data recording techniques regarding accuracy of data recording. Subject of this study is to proof the quality of a "point of care - computer-assisted" data recording technique within a "military setting".

METHOD

Prospective emergency room study at the multinational-staffed German Field Hospital Kabul/Afghanistan. A standardized emergency room data recording - using "TraumaWatch" - was performed parallel to the emergency room procedures; in each patient a tablet-PC-based technique ("pen group") as well as a traditional paper-based technique ("paper group") was used simultaneously by two nurses of the emergency room team. Data quality was defined as level of dataset completeness.

RESULTS

During a 3-month study period, a total number of 171 major trauma cases underwent emergency room management. There was no correlation between degree of injury severity and level of dataset completeness. Total dataset completeness was significantly higher within the "pen group" (93.9 ± 15.5% vs. 50.1 ± 21.8%; p < 0.01); the same applies to the core dataset (Utstein style) completeness (94.8 ± 15.1% vs. 48.9 ± 18.7%; p < 0.01).

CONCLUSION

Defining data quality as level of dataset completeness, a tablet-PC-based recording technique, which allows easy and fast - real-time - data acquisition during emergency room management, seems to be superior to the conventional paper-based technique - even under the conditions of a military mission.