Decreasing Newborn Screen Rejection Rate…Keys to Success

Purpose for the program: In February 2010, Yuma Regional Medical Center was notified by the Office of Newborn Screening in the State of Arizona that our newborn screen rejection rate was 15.8%;  this rate far exceeded the State’s goal of a rejection rate of < 1 %.  .

Proposed change: We immediately developed a quality improvement initiative regarding newborn screens

Implementation, outcomes and evaluation:   Collaboration with our State lab as well as our organization’s lab was a key intervention in this initiative.  We began by closely looking at why each specimen was rejected and who obtained the specimen.  After it was determined that there were a wide variety of reasons for the rejection rate, as well as people involved an ongoing educational effort began.  This effort included mandatory in-services for all staff including lecture, demonstrations, and return demonstrations.  We also seized every opportunity to talk about newborn screens, their importance, and correct collection.  Opportunities included shift change report, one on ones, bulletin boards, and staff meetings. 

Another intervention included, two nurses checking each specimen before it was sent to the lab and the lab staff checked the specimen again before being sent out to the State lab.  In addition, we focused on newborn screens at our annual skills lab competency with more hands on demonstrations. 

We requested monthly rejection rate stats from the State lab and continued to look at each rejected specimen report.  One on one coaching occurred when necessary to assure proper techniques were being used.  Each month after this initiative our rejection rate declined, from April 2010-June 2010 we had a total of 1055 screens with 13 rejected which is a rejection rate of 1.2%.  In the month of June, we had a rejection rate of < 1 %.  Since our rapid decline in our rejection rate, we have had State visits to review our interventions so they can be shared with other hospitals in our state that have been unsuccessful in decreasing their rejection rate.   This quality improvement initiative improved the care we provided to our newborns and their families.

Implications for nursing practice: In the United States each year, approximately 5000 newborns are diagnosed with serious conditions by results obtained from a newborn screen.  Nurses play a key role in the collection of the blood spot for these tests.  A rejected specimen can result in delay of diagnosis and subsequently a delay in treatment of these conditions.

Keywords: Newborn Screen Rejection Rate Quality Initiative