Purpose for the Program
To develop an interdisciplinary program of universal screening for congenital cardiac heart disease (CCHD) based on the 2011 American Academy of Pediatrics recommendations for the 4,000 term and late-preterm infants cared for in our mother–baby unit.
Before implementation of this evidence-based practice change, only symptomatic newborns had screening and diagnostic evaluation. Through the CCHD screening program, all newborns receiving care in the mother–baby unit benefit from early screening to determine the risk of CCHD. Based on positive-pulse oximetry screening, infants at risk receive a predischarge diagnostic echocardiogram and evaluation by a pediatric cardiologist, with follow-up as indicated.
Implementation, Outcomes, and Evaluation
An interdisciplinary committee of physicians, nurses, and advanced practice nurses met to review the literature, evaluate current practice, and develop plans for implementation of CCHD risk identification and referral for diagnostic and cardiology follow-up. Implementation strategies included the following: developed a policy for newborn CCHD screening; revised preprinted order sets/protocols; developed procedure for pulse oximetry screening; completed physician education, nurse education, and competencies related to the screening program; obtained additional equipment; established the coordination of diagnostic echocardiogram and cardiology referrals for positive-pulse oximetry screens; revised documentation forms to include CCHD screen/referrals; developed patient teaching guidelines and written education materials; and established the communication of the results to the newborn's primary care provider. This collaborative initiative resulted in a change in the standard of practice to improve the outcomes and safety of newborns that may be at risk of morbidity and mortality due to unknown cardiac factors. Screening through pulse oximetry provides an inexpensive, noninvasive tool to identify newborns with structural heart defects, which usually are associated with hypoxia and physiologic changes in the newborn period that could have significant sequelae. Parents receive education about CCHD and the importance of postscreening follow-up with primary care providers or pediatric cardiology based on the results of the newborn CCHD screen.
Implications for Nursing Practice
The CCHD screening program is an example of interdisciplinary collaboration among nursing, medicine, and cardiology for universal identification, early diagnosis, and management of asymptomatic newborn cardiac pathology to prevent morbidity and mortality. Through assessment, pulse oximetry screening, and patient teaching, nurses are integral to the safety and well-being of newborns. This timely implementation of the 2011 American Academy of Pediatrics CCHD recommendations promotes the organization's mission of patient safety and can be a model to others for establishing CCHD screening programs.