Purpose for the Program
In September 2011, the Secretary of the U.S. Department of Health and Human Services recommended that all U.S. hospitals be required to screen newborns for critical congenital heart disease (CCHD). Screening for CCHD with the use of pulse oximetry also has been endorsed by the American Academy of Pediatrics, the American College of Cardiology Foundation, and the American Heart Association. The purpose of this project was to examine the current research and recommendations supporting the use of pulse oximetry as a method of screening newborns for CCHD and to implement a newborn screening program supported by this evidence.
To identify and address the implementation steps for initiating a neonatal CCHD pulse oximetry screening program.
Implementation, Outcomes, and Evaluation
A review of recent literature and evidence-based recommendations supported the need to make screening of every eligible newborn a standard of care in our facility. With the supporting evidence and recommendations in hand an interdisciplinary work group was established to implement a CCHD pulse oximetry screening program for newborns in our facility.
Implementation steps identified included the following: (a) policy and procedure development; (b) screening tool and documentation plan; (c) equipment and supply needs; (d) staff training and education; (e) parent education materials; (f) physician notification; (g) community education; and (h) tracking results and follow-up. Work was initiated and by January 1, 2012 we developed a policy and procedure and a screening form. The physician documentation of screen results was setup in our electronic medical record and equipment was in place. The staff training was completed and educational materials produced. The physicians were notified of the screening procedure and screening for CCHD with pulse oximetry was initiated on all eligible newborns delivered or admitted to UAMS, Medical Center. Ongoing review of the program by the work group continued to assess the need for program revisions as indicated. The policy and screening form were both revised after initial implementation to better address the screening of the ill infant. A plan to track all positive screening results has been initiated within our maternal/infant division to continue the assessment of our screening program, identify any false-positive results, and assess the medical follow-up of those infants identified with CCHD.
Implications for Nursing Practice
This project is an excellent example of taking current evidence and research and expanding it into evidence-based practice at the bedside and the necessity of interdisciplinary collaboration when introducing a new practice into a healthcare facility.