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Screening of conginital heart diseases

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Screening of conginital heart diseases

مُساهمة من طرف عبدالله يوسف صديق في الأربعاء مايو 29, 2013 2:25 am

Rapid Implementation of Pulse Oximetry Newborn Screening to Detect Critical Congenital Heart Defects

New Jersey, 2011

Lorraine F. Garg, MD, Mary M. Knapp, MSN, Leslie M. Beres, MS, Kim Van Naarden Braun, PhD, Cynthia F. Hinton, PhD, Cynthia H. Cassell, PhD, Richard S. Olney, MD, Cora Peterson, PhD, Jill Glidewell, MSN, MPH
DisclosuresMorbidity & Mortality Weekly Report. 2013;62(15):292-294.








  • Introduction






Introduction

In August 2011, New Jersey implemented a statewide newborn screening protocol for critical congenital heart defects (CCHD) using pulse oximetry. In January 2012, CDC responded to a request from the New Jersey Department of Health (NJDOH) to assist with an assessment of the implementation. Out of the 52 birthing facilities in New Jersey, a sample of 11 was selected. Staff interviews were conducted to assess screening and data collection processes, data flow and tracking procedures, electronic medical record (EMR) capabilities, and capacity to report data to NJDOH. Feedback also was obtained about the questionnaire being used to follow-up on positive screening results. All 11 facilities were screening for CCHD. Among the 11 facilities, three were electronically entering and maintaining data into an EMR, five were manually entering and maintaining data into paper charts and logs, and three were both electronically and manually entering and maintaining data. Facilities reported that implementation of newly mandated CCHD screening posed a low burden to hospital staff members. NJDOH receives aggregate pulse oximetry screening data from all New Jersey birthing facilities. During the first 3 months of screening, preliminary data indicated that 98.2% of 25,214 newborns were screened. Hospitals reported data on 12 newborns with positive screening results; two newborns were newly diagnosed with CCHD as a result of pulse oximetry screening. Because of state-specific factors, such as out-of-state referral patterns, these findings might underestimate the anticipated number of positive screens in states with varying referral patterns and use of prenatal diagnosis. Rapid implementation of universal CCHD screening posed a relatively low burden to hospitals in New Jersey.
The system assessment began in January 2012 (5 months after hospitals commenced routine screening). The objectives were to assess EMR capabilities, assess the capacity to report screening data to NJDOH, and evaluate the data flow and tracking at a sample of birthing facilities. As part of this investigation, 11 of 52 New Jersey birthing hospitals were visited. Four of these birthing facilities were included because they had identified newborns with positive screening results during the first 3 months of implementation. The other seven hospitals were selected as a random sample of all other birthing facilities in the state, stratified by geographic location, hospital birth census, and hospital level of care.
NJDOH's mechanism for pulse oximetry surveillance includes collection of aggregate data reports from each licensed birthing facility and reports of positive screening results to the confidential New Jersey Birth Defects Registry (NJBDR). The aggregate data reports submitted to NJDOH contain the number of live births, number of newborns screened, an explanation of any discrepancies between those numbers, and the number of positive screens. During the investigation, NJDOH staff members shared results of these preliminary aggregate screening data from the first 3 months of system operation (August 31–November 30, 2011).
A structured questionnaire with open-ended questions was developed by the investigation team and distributed to hospitals before the field investigation. Face-to-face interviews were conducted by CDC and NJDOH personnel to assess pulse oximetry screening procedures, data collection and maintenance procedures, reporting practices, and burden (i.e., increased workload or additional duties) of screening and reporting by hospital staff. Staff members were asked to rate the level of burden on a scale ranging from 1 = no burden to 10 = very burdensome. Key personnel, such as well baby nursery and neonatal intensive care unit managers and staff nurses, clinical educators, and representatives from the hospital's biomedical services department, participated in each interview. Medical charts were reviewed with hospital staff members at the four facilities that previously had reported positive screens and the process of reporting data to NJDOH was discussed. Feedback on the questionnaire being used for follow-up of positive screens was obtained from facility staff members. Members of the investigation team observed pulse oximetry screening and documentation practices in each hospital's well baby nursery and neonatal intensive care unit.

All 11 hospitals had incorporated screening for CCHD into routine nursing care in their well baby nurseries and neonatal intensive care units. Hospital nurses reported that the addition of the newly mandated screening processes posed minimal burden (average score 2.1). Nurses indicated that pulse oximetry was a familiar skill and screening all newborns was easily incorporated into their routine tasks. Three of the 11 hospitals were electronically entering and maintaining data in an EMR, five of the 11 were manually entering and maintaining data into paper charts or logs, and three of the 11 were both electronically and manually entering and maintaining data. All facilities had mechanisms for collecting and reporting aggregate screening data to NJDOH and positive screening results to NJBDR. All facilities reported that aggregate screening data would be submitted to NJDOH as requested. Hospitals reported the process of submitting aggregate screening data to NJDOH posed a moderate burden (average score 4.2) to staff members. Hospitals requested a form with detailed instructions to report discrepancies between the number of live-births and number of newborns screened for future aggregate screening data requests. All facilities reported that individual-level screening and clinical data would be reported to NJBDR for positive screening results. The NJBDR follow-up questionnaire was modified based on feedback from nurses.
In the first 3 months following implementation of the mandate to screen all newborns for CCHD using pulse oximetry, preliminary data indicated that 98.2% of 25,214 newborns born in licensed birthing facilities were screened, with 12 positive screens. Two positive screens were confirmed CCHD cases initially detected by pulse oximetry screening (no prior diagnosis), which otherwise might have resulted in death or disability.
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عبدالله يوسف صديق

عدد المساهمات : 240
تاريخ التسجيل : 14/10/2011
العمر : 48
الموقع : السعودية- جامعة الحدود الشمالية

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