Decreasing the Hearing Screen Referral Rate, One Unit's Experience
- Identify strategies to choose key people to perform the hearing screens.
- Discuss policy formulation, training, and information regarding the importance of accurate screens.
- Describe a system to monitor and track referrals and staff accuracy of following the policy to the set goal.
Universal Newborn Hearing Screening (UNHS) programs promote the hearing screening of all newborns along with early intervention to prevent the negative consequences associated with the late diagnosis of hearing loss. UNHS goals call for a referral rate of less than 4%. Prior to implementation of this project, CMC-NE had an average monthly referral rate of 7%, which is well above the benchmarks for the state.
Proposed change:
Using a multidisciplinary approach, our facility reduced the newborn hearing screening refer rate to below 4% per month. We defined the problems for performance improvement and the measurement of improvement by auditing referrals from the previous 12 months, tracked the number of newborns screened, the pass and refer rates, and the missed screens. We standardized the hearing screen process by updating the competency, retraining each screener, updating the protocols, and emphasizing the importance of reducing referrals and understanding of why detection of early hearing loss is important. We tracked referrals monthly by screener and re-educated as needed. This increased accountability and improved practice. To maintain the competence, we revalidated skills in an annual skills fair.
Implementation, outcomes and evaluation:
The performance improvement project is ongoing. We have averaged a monthly referral rate below 4% for 10 months, with the most recent being 2.2%. We have all but eliminated missed hearing screens with only 5 since implementation of the PI project in September 2009, and none in 2010. We continue to track refers monthly for trends. The most significant trend has been the lack of a second screen prior to discharge on newborns who refer the first screen. We continue to work toward achieving this goal. Our state audiology site visit was very positive in which they praised our improvement and reported that our program is a model they will use as a benchmark for other hospitals. In fact, our audiologist is now listed as a point person for contact to other facilities regarding streamlining their hearing screening process.
Implications for nursing practice:
This process was a success because of the involvement of those who do the work (our screeners who are nursing assistants). Our improvement plan was entered into a quality symposium for our hospital system and won a Silver Award. We rewarded staff for a successful project with a celebration during a staff meeting, which included individual gifts for each team member.
Keywords:
reducing newborn hearing referral rates
