Their Hearts in Our Hands: Implementation of Screening for Critical Congenital Heart Defects (CCHD's) in a Level One Nursery

Purpose for the program: The purpose of this presentation is to describe how through the use of an evidence based tool kit developed by the Children's National Medical Center (CNMC), we have been able to implement pulse oximetry screening for Critical Congenital Heart Defects (CCHD's) in our Level One Nursery. Universal CCHD screening has been endorsed by the American Academy of pediatrics, the United Staes Department of Health  and Human Services (HHS), the National Association of Neonatal Nurses (NANN), other prominent helathcare organizations, and grassroots efforts by families of children who have been impacted by CCHD. Many infants who suffer from CCHD  are asymptomatic and may experience developmental delays, sudden onset of symptoms, or even unexpected death. Pulse oximetry is a non-invasive screening tool which has great potential to reduce both morbidity and mortality in the newborn population. Many states have passed legislation requiring that CCHD screening be offerred by hospital nurseries, but it is not yet mandated in Pennsylvania. Though we are a small community hospital, it is our hope to be a leader in the promotion of good health in our community.

Proposed change:  All neonates born at Hanover Hospital will screened for CCHD's, unless the procedure is declined by the family or the infant is transferred to another facility. Staff are trained to perform screening according to guidelines described in the toolkit. Families giving birth at our facility are informed of the screening in Childbirth Education Classes, written educational materials, and through bedside teaching with our nursing and pediatric medical staff. Data gathered will be shared with CNMC, pending approval of the Director of Hospital Information Management.

Implementation, outcomes and evaluation: Staff was trained to use equipment by demonstration and educated on evidence supporting screening with a powerpoint presentation. Screening was implemented in March, 2012. To date, 292 newborns have been screened, with one positive who was referred for outpatient follow-up.

Implications for nursing practice:  Neonates being cared for at our facility are being screened for CCHD using the most current guidelines. In response to initial misinterpretations, the  electronic medical record (EMR) has been modified to actively prompt the end user to rescreen, report, or conclude screening based on data entered. It is hoped that collaboration with CNMC to share our data may evolve into a relationship which may facilitate additional sharing of knowledge. 

Keywords: Newborn screening,  critical congenital heart defects CCHD's), pulse oximetry