Improved Outcomes From Newborn Screening Timeliness and Transcutaneous Hyperbilirubinemia Screening

Abstract

Our staff was routinely obtaining a heelstick specimen for both New York state (NYS) newborn screening as well as a serum bilirubin after midnight on the day of discharge. This was painful for the newborns and relatively time intensive for nursing. In addition, national recommendations, and eventually NYS regulations, for newborn screening specimen timing had decreased to Age 24–36 hours. Many of our specimens, particularly after cesarean births, were delayed. We wanted to implement a less painful, more efficient, hyperbilirubinemia screening and, by eliminating the need for a potential second heelstick, to improve our timing on newborn screening specimens. This project was granted an exemption by Montefiore Nyack Hospital’s Institutional Review Board. A grant was procured from our Ladies Auxiliary to purchase a transcutaneous bilimeter. Two units were trialed by nursing staff, results correlated, and one was chosen. Our policy and protocol were updated, and fields were created in the electronic medical record for documentation and review. Training was developed and administered both via the learning management system and live return demonstrations. NYS’s newborn screening report card statistics as well as number of serum bilirubin tests ordered were monitored. The timing of our newborn screening specimens improved immediately and by 3 months after the transcutaneous bilimeter go-live, we were ranked first in NYS. Serum bilirubins declined, which represented cost savings to the organization. There were several cases where the specimen was drawn just short of 24 hours, necessitating a repeat screen for the neonate. Individual employees were coached and reinforcement offered at staff meetings and huddles. Staff expressed great satisfaction with the new protocol, verbalizing that it was easy and could be used at anytime for a quick screen. We found an interdisciplinary transcutaneous hyperbilirubinemia screening protocol to be efficacious, efficient, and cost effective. Nurses are responsible for overseeing and, in many cases collecting, newborn blood specimens. Device selection by shared decision making increased adoption. As their patients’ advocates, nurses appreciate the improvement to patient comfort, ease of use, facilitation of better compliance with state regulations, and improved quality measures.