Getting to the Heart of the Matter: Implementing a Critical Congenital Heart Disease (CCHD) Newborn Screening Program Across a Rural Health System

Abstract

Purpose for the Program Critical congenital heart disease (CCHD) occurs in approximately 8 of 1,000 births. With shorter hospitalization stays, newborns without cardiac anomaly identification before birth may appear healthy during their hospitalization. CCHD may not be identified until the newborn is at home and in distress. Early identification and intervention of CCHD promotes optimal outcome for newborns. A CCHD screening program was implemented for newborns in six obstetric/newborn units across a rural health system before the mandated legislative requirement. Proposed Change To facilitate intervention for those normal appearing newborns with undiagnosed heart defects after birth, a screening protocol before discharge should be implemented by nurses to identify CCHD in newborns who are 24 hours of age. Implementation, Outcomes, and Evaluation An interdisciplinary healthcare team consisting of obstetric/newborn nursing leadership, clinical nurse specialist, respiratory therapy leadership, and neonatology and pediatric cardiology physicians collaborated to develop a specific protocol for CCHD newborn screening. Protocol development was initiated based on recommendations from the United States Secretary of Health and Human Services, the American Academy of Pediatrics, the American Heart Association, the introduction of state legislation for mandated CCHD screening by hospitals, and the evaluation of published evidence that identified the method for CCHD screening. Newborn nursing leadership developed the protocol and presented information for discussion and input to pediatric physicians across six healthcare facilities within the two state health system for adoption. Equipment was identified and acquired for each unit. Electronic health record modification assisted nursing team members to follow the protocol algorithm for accuracy. Nursing and respiratory therapy leadership developed a competency assessment for nursing team members and the comprehensive newborn nursing education plan for implementation. Since implementation in October 2011, approximately 4,700 infants have been screened with one true positive case of CCHD identified and two instances of false positive results where CCHD was ruled out with further testing. The minimal cost of implementation related to supplies and the time spent performing the test (3–4 minutes of nursing time per infant) has resulted in a successful program in which early identification of CCHD improves the outcome for those infants at risk. Implications for Nursing Practice The performance of CCHD screening by nurses facilitates the identification of CCHD in healthy appearing newborns with undiagnosed disease before ductal closure to promote timely intervention and optimal health outcomes. Nurses provide information and education to parents about the screening. Critical congenital heart disease (CCHD) occurs in approximately 8 of 1,000 births. With shorter hospitalization stays, newborns without cardiac anomaly identification before birth may appear healthy during their hospitalization. CCHD may not be identified until the newborn is at home and in distress. Early identification and intervention of CCHD promotes optimal outcome for newborns. A CCHD screening program was implemented for newborns in six obstetric/newborn units across a rural health system before the mandated legislative requirement. To facilitate intervention for those normal appearing newborns with undiagnosed heart defects after birth, a screening protocol before discharge should be implemented by nurses to identify CCHD in newborns who are 24 hours of age. An interdisciplinary healthcare team consisting of obstetric/newborn nursing leadership, clinical nurse specialist, respiratory therapy leadership, and neonatology and pediatric cardiology physicians collaborated to develop a specific protocol for CCHD newborn screening. Protocol development was initiated based on recommendations from the United States Secretary of Health and Human Services, the American Academy of Pediatrics, the American Heart Association, the introduction of state legislation for mandated CCHD screening by hospitals, and the evaluation of published evidence that identified the method for CCHD screening. Newborn nursing leadership developed the protocol and presented information for discussion and input to pediatric physicians across six healthcare facilities within the two state health system for adoption. Equipment was identified and acquired for each unit. Electronic health record modification assisted nursing team members to follow the protocol algorithm for accuracy. Nursing and respiratory therapy leadership developed a competency assessment for nursing team members and the comprehensive newborn nursing education plan for implementation. Since implementation in October 2011, approximately 4,700 infants have been screened with one true positive case of CCHD identified and two instances of false positive results where CCHD was ruled out with further testing. The minimal cost of implementation related to supplies and the time spent performing the test (3–4 minutes of nursing time per infant) has resulted in a successful program in which early identification of CCHD improves the outcome for those infants at risk. The performance of CCHD screening by nurses facilitates the identification of CCHD in healthy appearing newborns with undiagnosed disease before ductal closure to promote timely intervention and optimal health outcomes. Nurses provide information and education to parents about the screening.