Implementing a Screening Program for Congenital Cardiac Defects in Newborns in a Community Hospital Setting

Abstract

Newborn Care Poster Presentation Purpose for the Program Congenital cardiac defects account for 24% of infant deaths due to birth defects. Approximately 4,800 infants born annually have one of seven critical congenital heart defects (CCHDs): hypoplastic left heart syndrome, pulmonary atresia, tetralogy of Fallot, total anomalous pulmonary venous return, transposition of the great arteries, tricuspid atresia, or truncus arteriosus. Infants born with one of these seven CCHDs are at high risk of death and disability if they are not diagnosed and treated in a timely manner. Pulse oximetry screening can be used to help detect infants who are asymptomatic before discharge from the newborn nursery. Proposed Change Although certain hospitals routinely screen all newborns using pulse oximetry screening, it is not currently mandated as part of newborn screenings in most states. As of January 1, 2013, the State of Connecticut requires that all babies be screened for CCHDs before discharge. Implementation, Outcomes, and Evaluation The nursing team presented the state mandate to our multiprofessional Perinatal Quality and Safety Committee and conducted an exhaustive literature review to ascertain necessary steps in developing and implementing a CCHD screening program. A CCHD screening policy was developed by nursing and approved by the nursing shared governance councils and physician leadership. Nursing leadership presented at the monthly business meetings for the obstetric and pediatric departments to educate them on the state mandate, the CCHD screening policy, parent education handouts, process flow for performing screenings, and documentation of screening results. Consensus was reached at the Pediatric Departmental Business Meeting for interventions related to a failed screening or a positive test result. Education and competency evaluation were completed with all nursing staff conducting the screenings and with staff caring for women in labor or postpartum patients so that the staff would have knowledge of the state mandate and screening process when caring for new parents. Screenings were conducted (beginning in December 2012) to work through process improvement issues before the mandatory implementation date. The documentation tool was tweaked and parents were notified of screening results by the nurse performing the screening. During the first month of implementation, a reconciliation process was done with nursing leadership before discharge to ensure there were no missed screenings. Closed chart audits were conducted monthly on every patient to ensure accurate testing. Eight months after the state mandate, 1,556 infants were screened of 1,556 eligible patients. Implications for Nursing Practice Nursing-led initiatives can be the driving force in the implementation of evidence-based practice.