ABSTRACT
PURPOSE: The purpose of this project was to evaluate the benefits of an online nursing education program addressing the significance and rationale of an evidence-based critical congenital heart disease (CCHD) screening protocol using pulse oximetry implemented on full-term newborns delivered at an academic obstetric referral center. The aim was to assess nurses' knowledge of the protocol and nurses' adherence to the protocol documentation before and after the education module was implemented. SUBJECTS: Registered nurses working in the birthing center who completed the online knowledge tests and an education module. DESIGN: A repeated-measures quality improvement study was conducted to assess nurses' knowledge of the evidence supporting CCHD screening by pulse oximetry and adherence to the correct documentation of the screening protocol before, immediately after, and 3 months following participation in an online education module. METHODS: Nurses' knowledge of the CCHD screening protocol was determined by the number of correct answers on a 10-item online test administered before and after the education module. Adherence to correct documentation of the protocol before and after the education intervention was evaluated. The medical charts of 300 newborns delivered at the center with pulse oximetry readings performed after 24 hours of age and before discharge were randomly selected and reviewed. RESULTS: A significant improvement in knowledge test scores was observed immediately after the education module (9.1 ± 1.0), relative to baseline (8.4 ± 1.2; paired t = 3.02, P = .0046). A significant increase in knowledge test scores measured at baseline, immediately after, and 3 months postintervention was also indicated (F = 3.25; df = 2, 24; P = .0564). Documentation of the protocol in the medical charts for the location of the readings significantly improved after the educational intervention (right hand: 28%, 83%, and 90%; right foot: 27%, 82%, and 89%; both P < .0001). CONCLUSIONS: Providing education to staff before implementing new practice changes enhances their knowledge. Quality improvement monitoring is recommended to ensure nursing adherence to any practice change.
Subject(s)
Education, Nursing, Continuing , Health Knowledge, Attitudes, Practice , Heart Defects, Congenital/diagnosis , Neonatal Nursing/education , Neonatal Screening/methods , Oximetry , Documentation , Educational Measurement , Female , Humans , Infant, Newborn , Male , Quality Improvement , Retrospective StudiesABSTRACT
BACKGROUND AND OBJECTIVE: Critical congenital heart disease (CCHD) is endorsed by the US Secretary of Health and Human Services as part of the recommended uniform screening panel for newborns. Although initial recommendations for implementation exist, as states and hospitals have moved forward with implementation of screening, new challenges and areas for additional focus have been identified. The objective of this study was to develop recommendations to address current challenges and areas of focus surrounding CCHD newborn screening. METHODS: A workgroup of experts and stakeholders was convened in Washington, District of Columbia, for a 1-day meeting in February 2012. At the beginning of the meeting, the stakeholders held a brainstorming session to identify areas of main priority based on their experience. After this, stakeholders broke into small groups to refine recommendations, which were then finalized by consensus. RESULTS: Recommendations to address selection of screening equipment, standards for reporting of screening outcomes to stakeholders, training of health care providers and educating families, future research priorities, payment for screening, follow-up diagnostic testing, and public health oversight, and advocacy to facilitate effective and comprehensive screening were proposed. Suggestions for future work were developed. CONCLUSIONS: Screening for CCHD presents novel challenges and opportunities; however, addressing these will strengthen newborn screening and newborn care networks, and ultimately improve health outcomes.
Subject(s)
Health Plan Implementation/organization & administration , Heart Defects, Congenital/diagnosis , Neonatal Screening/organization & administration , Cause of Death , Cooperative Behavior , Cost-Benefit Analysis , Cross-Sectional Studies , District of Columbia , Education , Female , Follow-Up Studies , Health Plan Implementation/economics , Heart Defects, Congenital/economics , Heart Defects, Congenital/mortality , Humans , Infant, Newborn , Interdisciplinary Communication , Male , Neonatal Screening/economics , Neonatal Screening/instrumentation , Oximetry/instrumentation , United StatesABSTRACT
Congenital heart disease (CHD) is the most common birth defect and affects approximately 8 out of every 1,000 infants born each year. Despite antenatal screening and at least one examination before discharge infants with critical CHD (CCHD) are routinely not detected before discharge from the newborn nursery. Newborn screening for CCHD using pulse oximetry is widely endorsed however until recent efforts, CCHD screening programs had only been implemented at the individual hospital level. The purpose of this paper is to describe the implementation of CCHD screening across the entire Emirate of Abu Dhabi. The Health Authority-Abu Dhabi (HAAD), in collaboration with Children's National Medical Center (Children's National), successfully implemented CCHD screening at the emirate level using a "train-the-trainer," two-tiered approach, starting with two pilot hospitals then rolling the program out to all birthing facilities. In the first year, CCHD screening was added as a mandatory test to the HAAD Newborn Screening Standard, has been implemented in most birthing facilities, and occurs for the majority of infants (86 %) in Abu Dhabi. This led to the identification of ten newborns with CCHD. Based on the successful identification and mitigation of barriers to implementation, the approach may be adapted for similar programs in other populations.
