Implementing a Critical Congenital Cardiac Screening Program in a Community Hospital Setting

Purpose for the program:

 Congenital cardiac defects account for 24% of infant deaths due to birth defects.  Approximately 4800 babies born annually have one of seven critical congenital heart defects (CCHD's):  hypoplastic left heart syndrome, pulmonary atresia, tetralogy of Fallot, total anomalous pulmonary venous return, transposition of the great arteries, tricuspid atresia and truncus arteriosis.  Babies born with one of these seven CCHD's are at high risk for death and disability if they are not diagnosed and treated in a timely manner.  Pulse oximetry screening can be used to help detect asymptomatic babies prior to discharge from the newborn nursery.

Proposed change:

Though certain hospitals routinely screen all newborns using pulse oximetry screening, it is not currently mandated as part of newborn screenings in most states.  As of January 1, 2013, the State of Connecticut required all babies be screened for CCHD's prior to discharge.

Implementation, outcomes and evaluation:

The nursing team presented the state mandate to our multiprofessional Perinatal Quality and Safety Committee and conducted an exhaustive literature review to ascertain necessary steps in developing and implementing a CCHD Screening Program.  A CCHD Screening Policy was developed by nursing and approved by the nursing shared governance councils and physician leadership. Nursing leadership presented at the monthly business meetings for the Obstetrical and Pediatric Departments to educate them on the state mandate, the CCHD Screening Policy, parent education handouts, process flow for performing screenings, and documentation of screening results.  Consensus was reached at the Pediatric Departmental Business Meeting for interventions related to a failed screening or a positive result.

Education and competency evaluation was completed with all nursing staff conducting the screenings as well as staff caring for laboring or post partum patients so they would have knowledge of the state mandate and screening process when caring for new parents.

Screenings were conducted beginning in 12/12 so as to work through process improvement issues prior to the mandatory implementation date.  The documentation tool was tweaked and parents were notified of screening results by the nurse performing the screening. 

During the first month of implementation, a reconcilliation process was done with nursing leadership prior to discharge to ensure there were no missed screenings.  Closed chart audits are conducted monthly on every patient to ensure accurate testing.  Eight months into the state mandate, 1556 babies have been screened out of 1556 eligible patients.

Implications for nursing practice: Nursing led initiatives can be the driving force in the implementation of evidence based practice.

Keywords: CCHD Screening, cardiac defects, newborn screening