Newborn screening (NBS) is a state-required test in which blood is collected and analyzed for specific genetic, metabolic, hormonal and other disorders. If a disorder exists, life saving treatments and interventions can be initiated to facilitate the most healthy growth and development possible for the affected infant. Because early treatment is vital, state guidelines mandate that hospitals send blood samples for analysis within 24 hours of collection, and results be reported to hospitals and healthcare providers within 7 days of the infant’s birth.  Even though the nurses in our Mother/ Baby unit were knowledgeable about guidelines regarding NBS and how to prepare specimens, errors in specimen preparation, collection, and submission still existed.  These errors contributed to healthcare costs for parents and pediatricians and delayed the detection of potentially debilitating or fatal diseases.  Earlier in 2011, our specimen rejection rate was 2.5%. 

Proposed change:

To improve our ability to follow evidence-based guidelines regarding NBS, our nurses were required to complete the NC State Laboratory of Public Health online training. Once the training was complete, nurses observed specimen collection under the supervision of a preceptor before they collected specimens independently. We selected a team of nurses to become experts in NBS. These nurses were provided with additional education on common mistakes when performing collections. In addition, several new processes were implemented within the unit.  A new practice was implemented for collecting blood by warming the infant’s heel to facilitate blood flow. A new method for collecting guardian demographic information was implemented to ensure notification in the event of a serious diagnosis. Finally, properly drying the filter paper was emphasized. 

Implementation, outcomes and evaluation:

After implementing new measures, we conducted a three-month trial of our new processes.  Of the 1,297 samples sent to the NC State Laboratory, only three were rejected (0.23%), a 10% improvement from our previous rate.  In addition, no complaints have been filed from local pediatricians or our hospital’s risk management team.

Implications for nursing practice:

Our new processes for collection and submission of NBS specimens have shown positive results. We continue to emphasize education and strict adherence to collection methods.  Although our rejection rate is small, we realize that even one missed result may change a life. The results of a properly collected NBS can save an affected newborn from suffering lifelong disability, mental retardation, and sometimes death.

Keywords:

Newborn, Screening, NBS, PKU