Preventing a Broken Heart: Critical Congenital Heart Disease Screening
Title: Preventing a Broken Heart: Critical Congenital Heart Disease Screening
- Describe the rationale for universal screening of newborns for critical congenital heart disease screen (CCHD).
- List criteria for negative CCHD screen and for positive CCHD screens that require follow-up evaluation
- Identify components of an interdisciplinary, collaborative initiative to prevent cardiac events through a program of screening and early identification, referral, and management.
Proposed change: Prior to implementation of this evidence-based practice change, only symptomatic newborns had screening and diagnostic evaluation. Through the CCHD Screening Program, all newborns receiving care on the mother-baby unit benefit from early screening to determine CCHD risk. Based on positive pulse oximetry screening, infants at risk receive a pre-discharge diagnostic echocardiogram and evaluation by a pediatric cardiologist, with follow-up as indicated.
Implementation, outcomes and evaluation: An interdisciplinary committee of physicians, nurses, and advanced practice nurses met to review the literature, evaluate current practice, and develop plans for implementation of CCHD risk identification and referral for diagnostic and cardiology follow-up. Implementation strategies included the following: Developed a policy for newborn CCHD screening; revised preprinted order sets/protocols; developed procedure for pulse oximetry screening; completed physician education, nurse education, and competencies related to the screening program; obtained additional equipment; established the coordination of diagnostic echocardiogram and cardiology referrals for positive screens; revised documentation forms to include CCHD screen/referrals; developed patient teaching guidelines and written education materials; and established the communication of results to newborn’s primary care provider. This collaborative initiative resulted in a change in the standard of practice to improve the outcomes and safety of newborns that may be at risk for morbidity and mortality due to unknown cardiac factors. Screening through pulse oximetry provides an inexpensive, non-invasive tool to identify newborns with structural heart defects usually associated with hypoxia and physiologic changes in the newborn period that could have significant sequella. Parents receive education about CCHD and the importance of post-screening follow-up with primary care providers or pediatric cardiology based on the results of the newborn CCHD screen.
Implications for nursing practice: The CCHD Screening Program is an example of interdisciplinary collaboration among nursing, medicine, and cardiology for universal identification, early diagnosis, and management of asymptomatic newborn cardiac pathology to prevent morbidity and mortality. Through assessment, pulse oximetry screening, and patient teaching, nurses are integral to the safety and well-being of newborns. This timely implementation of the 2011 American Academy of Pediatrics CCHD recommendations promotes the organization’s mission of patient safety and can be a model to others for establishing CCHD screening programs.
Keywords: Critical congenital heart disease, CCHD screening