Do You Know Who's At Risk? Screening for Critical Congenital Heart Disease Using Pulse Oximetry
Title: Do You Know Who's At Risk? Screening for Critical Congenital Heart Disease Using Pulse Oximetry
- Identify the need to integrate a recommended program into current nursing practice.
- Formulate a framework to implement a recommended practice for evidenced-based practice in neonatal care.
- Select an algorithm/screening tool to enhance the clinical decison making process for analzying screening results and follow up evaluation.
Congenital heart disease (CHD) is a common birth defect affecting approximately 8 out of every 1000 newborn infants. Infants with critical CHD may appear asymptomatic during the first few days of life. Timely diagnosis of this disease is critical to the well being of these infants. Early detection of critical CHD can help improve the prognosis and decrease both the morbidity and mortality rates of affected infants. What is the best approach to implementing a practice change in a large community academic teaching center?
Proposed change:
Following the recommendations of the American Academy of Pediatrics and the American Heart Association , a multidisciplinary team at a Level III hospital convened to determine the best way to implement a critical congenital heart disease program. A review of the literature identified pulse oximetry as a useful screening tool for critical CHD. Pulse oximetry is non-invasive, readily available, cost effective and can be performed by the bedside nurse. Used in conjuction with the physical examination, pulse oximetry can help identify infants who may require further evaluation. The proposed change was to implement bedside screening for critical CHD using pulse oximetry.
Implementation, outcomes and evaluation:
The implementation process and education process for our practice change began in January 2012. A timeline will be presented to outline our implementation process that included policy development, staff education, a time management pilot and documentation changes. In February, we began the pilot to screen infants betwee 24 to 28 hours of age. At the conclusion of the three month pilot, over 1200 infants were screened for critical CHD. Three infants were identified as "at risk" and required additional evaluation and follow up.
Challenges and barriers often present themselves when implementing a practice change. Sharing those opportunities can be an educational process for others. For example, our pulse oximetry equipment led to the decision to perform our oxygen saturation readings in direct sequence as opposed to parellel readings. Improved communication between nurses and physicians led to the development of a follow up evaluation process and improved electronic documentation.
Implications for nursing practice:
Our program was strengthened by the utilization of an algorithm that guided the clinical decision making process when analzying screening results. Education and practice sessions reinforced staff awareness and skills required to perform critical CHD screening. Ongoing evaluation of our current process allows us to assess the value of our process and implement change when necessary to improve our program.
Keywords: congenital heart disease, pulse oximetry, newborn screening, program implementation