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Table 3 Proposed A&F intervention components

From: Evaluation of an audit and feedback intervention to reduce gentamicin prescription errors in newborn treatment (ReGENT) in neonatal inpatient care in Kenya: a controlled interrupted time series study protocol

# Intervention component CP-FIT hypothesesa: feedback interventions are more effective when as follows: Package 1 Package 2 Control mechanism
1 The pharmacists have proposed roles as QI champions/facilitators. They will be supported to conduct a preliminary session for orientating clinical interns into the study when they start their 3-month rotation in paediatric and newborn wards. They will also encourage the nursing staff to identify prescription dosing errors and politely feed this back to the medical staff together with the paediatricians. They will help disseminate monthly reminders on dosing instructions during their physical interactions with NBU ward staff a) Champions: Supportive individuals in the organisation dedicated to making changes a success
b) Competing priorities: Clinical teams have minimal additional responsibilities and/or competing priorities
c) Workflow fit: Feedback and action fit alongside existing organisational and team ways of working
These elements contribute to effectiveness by promoting credibility of the feedback, limiting the resources needed to provide or act on feedback, and employing social influence in support of a need for behaviour change
Control variable
2 The pharmacists will also conduct 2-monthly routine continuous medical education (CME) sessions and review the performance A&F summaries with the newborn unit team for 15 min in the monthly morbidity and mortality meetings for the whole team or any other suitable forum at the local hospital a) Knowledge and skills in clinical topic and quality improvement: Feedback targets health professionals with greater capability in the clinical topic under focus
b) Source knowledge and skill: Delivered by a person or organisation perceived to have an appropriate level of knowledge or skill
c) Delivery to a group: Feedback delivered to groups of recipients
These elements contribute to effectiveness by relying on social influence to enhance feedback credibility and acceptance, building HCWs knowledge and skills to facilitate action, and, when emphasising a common goal, leveraging teamwork to target HCWs’ perception, intention, and behaviour
Control variable
3 The pharmacists will also be members of a WhatsApp group whose purpose is to facilitate conversations about prescription practices between fellow pharmacists in hospitals in the same study arm. The membership of this WhatsApp group is limited to pharmacists only. The WhatsApp group will be used to disseminate monthly reminders on dosing instructions to be shared with the rest of hospital-specific clinical team a) Peer discussion: Feedback encourages recipients to discuss their performance with peers
This element targets feedback perception and intention, by leveraging social influence to break down feedback’s complexity, and identifies possible practice improvements
Control variable
4 The pharmacists will also be members of an additional “within hospital” WhatsApp group whose purpose is to facilitate conversations about prescription practices with their hospital’s healthcare workers posted to the NBUs a) Delivery to a group: Feedback is delivered to groups of recipients
b) Peer discussion: Feedback encourages recipients to discuss their feedback performance with peers
c) Problem-solving and teamwork: Feedback supports recipients to identify and develop solutions to reasons for suboptimal performance
d) Action planning: Feedback provides solutions to suboptimal performance (or support recipients to do so)
These elements target feedback’s actionability by evaluating if practice context is compatible with the expected target goals. They promote perception and intention by leveraging social influence to break down feedback’s complexity when identifying possible practice improvements.
  “Control” arm
5 An interactive digital application platform that is mobile-friendly and auto-updated monthly used to deliver the enhanced A&F report summaries. The content of the interactive A&F feedback platform will be made up of three visualisationsb a) Automation: Data collection and analysis are (near) automatic
b) Active delivery: They “push” feedback messages to recipients rather than requiring them to “pull”
c) Usability: Feedback delivered employs user-friendly designs
d) Performance level, timeliness, trend, and benchmarking: Feedback uses recent data to communicate when recipients’ current performance has room for improvement, how recipients’ current performance in relation to their past performance, and compares recipients’ current performance to that of other NBUs
e) Importance, controllability, and relevance: Feedback focuses on meaningful goals perceived to be in HCWs control and relevant to their role
These elements seek to improve perception of and interaction with feedback and provide a relative advantage based on whether the cost of deploying feedback is considered inexpensive in terms of time, human, or financial resources. They also seek to promote social influence on (and perception of) feedback while solidifying its actionability, credibility, and acceptance and supporting intention for behaviour change
  “Control” arm
6 Enhanced A&F soft-copy (PDF) infographic report generated monthly outlining the proportion of patients who received erroneous gentamicin prescriptions, delivered to the NBU team. These additional A&F reports will be delivered to both the hospital pharmacists, the consultant paediatrician or neonatologist in charge of the neonatal unit, senior nurses, and the medical staff working on rotation in the unit for the duration of the study a) Usability: Feedback delivered employs user-friendly designs
b) Performance level, timeliness, trend, and benchmarking: Feedback uses recent data to communicate when recipients’ current performance has room for improvement, how recipients’ current performance in relation to their past performance, and compares recipients’ current performance to that of other NBUs
c) Importance, controllability, and relevance: Feedback focuses on meaningful goals perceived to be in HCWs control and relevant to their role
These elements seek to improve perception of and interaction with feedback and provide a relative advantage based on whether the cost of deploying feedback is considered inexpensive in terms of time, human, or financial resources. They also seek to promote social influence on (and perception of) feedback while solidifying its actionability, credibility, and acceptance and supporting intention for behaviour change
  “Control” arm
  1. aConcepts are expounded upon in detail elsewhere: (Brown, B., Gude, W.T., Blakeman, T. et al. Clinical Performance Feedback Intervention Theory (CP-FIT): a new theory for designing, implementing, and evaluating feedback in health care based on a systematic review and meta-synthesis of qualitative research. Implementation Sci 14, 40 (2019).https://doi.org/10.1186/s13012-019-0883-5)
  2. bDiscussed in-depth in Additional file 1: Supplementary Table 1