Pharmacist-supported audit and feedback intervention to reduce Gentamicin prescribing errors in neonatal inpatient care in Kenya: a natural experiment using interrupted time series analysis

Abstract

Abstract Background Approximately 14.9% of medications prescribed during hospital care in low- and middle-income countries (LMICs) contain errors, with neonates who experience high morbidity and mortality in these settings being particularly vulnerable. Gentamicin, a common first-line antibiotic for treating neonatal infections in LMICs including Kenya, is similarly prone to frequent prescribing errors. Nevertheless, evidence on effective interventions to improve prescribing practices in such contexts remains limited. Objective Our objective was to evaluate a theory-informed, pharmacist-supported audit and feedback (A&F) intervention aimed at improving routine prescribing practices, with an initial focus on reducing gentamicin prescribing errors in neonatal care. Methods We used interrupted time series analysis to model fluctuations in prescribing errors for neonates ≤ 28 days admitted to newborn units (NBU) in 22 hospitals in Kenya between July 2021 to June 2024 and explored intervention effects in a feedback meeting at the end of the study. The study had three phases, pre-intervention period (July 2021 to June 2022), intervention period (July 2022 to June 2023), and post-intervention period (July 2023 to June 2024). The primary study was a standard single-group interrupted time-series study (ITS) design to evaluate the comparative effectiveness of enhanced A&F in reducing prescribing error trends after its introduction in sixteen hospitals. Secondary analysis included comparison to prescribing error outcomes in an additional six hospitals in a contemporaneous comparison group that received basic A&F reports without pharmacist involvement in the NBU prescribing practices. Results Between July 2021 and June 2024, the sixteen hospitals in the primary outcome analysis and the six additional hospitals for the secondary outcome analysis had 36,668 and 8,943 neonates with Gentamicin prescriptions at admission retrospectively. From the incidence rate ratios (IRR) of incorrect prescribing at admission, there was no step change (IRR 1.115, 95% CI: 0.920 to 1.352, p-value = 0.265) or trend change (IRR 1.014, 95% CI: 0.986 to 1.042, p-value = 0.344) due to the enhanced pharmacist-supported A&F intervention in the sixteen hospitals in the primary study. From the secondary study, change in the trend post-intervention in the sixteen primary study hospitals in the primary study relative to the six hospitals acting as a contemporaneous comparison group was positive (IRR 0.933, 95% CI: 0.878 to 0.985, p-value = 0.014), despite no step change due to the enhanced A&F intervention. Conclusion We found no statistically significant effect of the team-based pharmacist-supported A&F intervention on reducing gentamicin medication errors in neonatal care. Prescribing errors during intervention and post-intervention periods were increasing across all hospitals in both arms of the study during and post-intervention periods. However, relative to comparison hospitals sites receiving routine feedback but without pharmacist involvement or pharmacist-supported CMEs, the primary study sites had a positive trend in reducing Gentamicin prescription error rates at admission during and post-introduction of the pharmacist-supported A&F intervention. Trial registration PACTR , PACTR202203869312307. Registered 17th March 2022, https://pactr.samrc.ac.za/Search.aspx?TrialID=PACTR202203869312307 .