Implementation of a Critical Congenital Heart Disease Pulse Oximetry Screening Program for Newborns

Purpose for the program:  In September of 2011 the Secretary of the U.S. Department of Health and Human Services recommended that all U.S. hospitals be required to screen newborns for Critical Congenital Heart Disease (CCHD). Screening for CCHD with the use of pulse oximetry has also been endorsed by the American Academy of Pediatrics, American College of Cardiology Foundation and the American Heart Association. The pupose of this project was to examine the current research and recommendations supporting the use of pulse oximetry as a method of screening newborns for CCHD and to implement a newborn screening program supported by this evidence.

Proposed change:  Identify and address the implementation steps for initiating a neonatal CCHD pulse oximetry screening program.

Implementation, outcomes and evaluation: A review of recent literature and evidence-based recommendations supported the need to make screening of every eligible newborn a standard of care in our facility.  With the supporting evidence and recommendations in hand an interdisciplinary work group was established to implement a CCHD pulse oximetry screening program for newborns in our facility. 

Implementation steps identified included (1) Policy & Procedure development (2) Screening tool & documentation plan (3) Equipment & Supply Needs (4) Staff training and education (5) Parent education materials (6) Physician notification (7) Community education and (8) Tracking results and follow-up.  Work was initiated and by January 1, 2012 we had developed a policy & procedure, a screening form, physician documentation of screen results was set up in our electronic medical record, equipment was in place; staff training was completed, educational materials produced, physicians notified of screening procedure and screening for CCHD with pulse oximetry was initiated on all eligible newborns delivered or admitted to UAMS, Medical Center.  Ongoing review of the program by the work group continued to assess the need for program revisions as indicated. The policy and screening form were both revised following initial implementation to better address the screening of the ill neonate.  A plan to track all positive screening results (failed screens) has been initiated within our Maternal/infant Division to continue the assessment of our screening program; identify any false-positive results and assess the medical follow-up of those infants identified with CCHD.

Implications for nursing practice: This project is an excellent example of taking current evidence and research and expanding it into evidence-based practice at the bedside and the necessity of interdisciplinary collaboration when introducing a new practice into a healthcare facility.

Keywords: CCHD, Critical Congenital Heart Disease, Pulse oximetry screen, Newborn pulse oximetry screen