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Getting to the Heart of the Matter: Implementing A Critical Congenital Heart Disease (CCHD) Newborn Screening Program Across A Rural Health System
Title: Getting to the Heart of the Matter: Implementing A Critical Congenital Heart Disease (CCHD) Newborn Screening Program Across A Rural Health System
- Recall the incidence, physiology, and presentation of CCHD in the newborn population.
- Discuss the evidence and recommendations for in-hospital pulse oximetry newborn screening for CCHD
- Describe the development of a health system in-hospital protocol/program for CCHD screening in the newborn
CCHD occurs approximately 8/1000 births. With shorter hospitalization stays, newborns without cardiac anomaly identification prior to birth may appear healthy during hospitalization. CCHD may not be identified until the newborn is at home and in distress. Early identification and intervention of CCHD promotes optimal outcome for newborns. A CCHD screening program was implemented for newborns in six obstetric/newborn units across a rural health system prior to the mandated legislative requirement.
Proposed change:
A CCHD screening protocol to be implemented by nurses caring for newborns at 24 hours of age to identify CCHD prior to discharge to facilitate intervention for those normal appearing newborns with undiagnosed heart defects after birth.
Implementation, outcomes and evaluation:
An interdisciplinary healthcare team of obstetric/newborn nursing leadership, Clinical Nurse Specialist, respiratory therapy leadership and Neonatology and Pediatric Cardiology physicians collaborated to develop a specific protocol for CCHD newborn screening. Protocol development was initiated based on recommendations from the United States Secretary for Health and Human Services, the American Academy of Pediatrics and the American Heart Association, the introduction of state legislation for mandated CCHD screening by hospitals, and evaluation of published evidence identifying the method for CCHD screening. Newborn nursing leadership developed the protocol and presented information for discussion and input to pediatric physicians across six healthcare facilities within the two state health system for adoption. Equipment was identified and acquired for each unit. Electronic health record modification assisted nursing team members to follow the protocol algorithm for accuracy. Nursing and Respiratory Therapy leadership developed a competency assessment for nursing team members and the comprehensive newborn nursing education plan for implementation. Since implementation in October 2011, approximately 4700 infants have been screened with one true positive case of CCHD identified and two instances of false positive where CCHD was ruled out with further testing. The minimal cost of implementation related to supplies and 3-4 minutes of nursing time per infant has resulted in a successful program in which early identification of CCHD improves the early intervention for those infants at risk.
Implications for nursing practice:
The performance of CCHD screening by nurses facilitates the identification of CCHD in healthy appearing newborns with undiagnosed disease prior to ductal closure to promote timely intervention and optimal health outcomes. Nurses provide information and education to parents about the screening.
Keywords:
Newborn Screening, Critical Congenital Heart Disease (CCHD), CCHD In-hospital Program Implementation