newborn hearing screening protocol (cg570) protocols and guideline… ·...
TRANSCRIPT
Author: Jo Young, Ali McMaster Date: April 2018
Job Title: Team Lead, Local Manager Review Date: April 2020
Protocol Lead: Group Director Urgent Care Version: 2.0 ratified 6/4/18
Location: Policy hub/ Clinical/Maternity/ Postnatal/ CG570
This document is valid only on date last printed Page 1 of 14
Newborn Hearing Screening Protocol (CG570)
Approval
Approval Group Job Title, Chair of Committee Date
Maternity & Children’s Services Clinical Governance Committee
Chair, Clinical Governance Committee
6th April 2018
Change History
Version Date Author, job title Reason
1.0 March 2016
Jo Young, Team Lead Trust requirement
2.0 March 2018
Ali McMasters, Newborn Hearing screening manager
Review due
Author: Jo Young, Ali McMaster Date: April 2018
Job Title: Team Lead, Local Manager Review Date: April 2020
Protocol Lead: Group Director Urgent Care Version: 2.0 ratified 6/4/18
Location: Policy hub/ Clinical/Maternity/ Postnatal/ CG570
This document is valid only on date last printed Page 2 of 14
Newborn Hearing Screening protocol (CG570) April 2018
Contents
1.0 Purpose .......................................................................................................... 3
2.0 Scope .................................................................................................................. 3
3.0 Process .............................................................................................................. 3
4.0 Roles and Responsibilities ............................................................................... 7
5.0 Consultation Undertaken PHE National newborn hearing programme ........ 8
6.0 Dissemination/Circulation/Archiving ............................................................... 8
7.0 Training .............................................................................................................. 8
8.0 Monitoring of Compliance ................................................................................ 8
9.0 Supporting Documentation and References ................................................. 10
9.1 NHSP Contacts ................................................................................................ 10
Appendix 1 - Well baby Protocol .......................................................................... 11
Appendix 2 - Newborn hearing screening NICU or NNU Protocol ..................... 12
Appendix 3 - Decline of screening- well baby ..................................................... 13
This document must be read in conjunction with:
Map of medicine www.hearing.screening.nhs.uk
Infection Prevention and Control Reporting and Responsibilities Policy (CG077)
Non Attendees at Antenatal Clinics / No Access Visits protocol (CG499)
Author: Jo Young, Ali McMaster Date: April 2018
Job Title: Team Lead, Local Manager Review Date: April 2020
Protocol Lead: Group Director Urgent Care Version: 2.0 ratified 6/4/18
Location: Policy hub/ Clinical/Maternity/ Postnatal/ CG570
This document is valid only on date last printed Page 3 of 14
Newborn Hearing Screening protocol (CG570) April 2018
1.0 Purpose
This protocol will enable trained newborn hearing screeners to perform newborn hearing
screening in accordance with the National Newborn Hearing Screening Programme. It will
enable early identification of potential hearing loss in newborns to audiology for optimum
outcome. Early identification of hearing impairment gives children a better chance of
developing speech and language skills, and of making the most of social and emotional
interaction from an early age.
The protocol defines roles and responsibilities for The Hearing Screening Team, Neonatal
Unit Staff and Audiology.
2.0 Scope
The newborn hearing screening protocol covers screening for detecting hearing impairment
in newborn babies. The target condition for the screen is bilateral, permanent hearing
impairment (sensorineural or permanent conductive) averaging 40dB or more in the better
ear. The aim is to complete screen by 4 weeks of age.
3.0 Process
The eligible population is any baby born to mothers whom registered GP practice is the
agreed boundaries of responsibility of RBH. This will include babies we are responsible for
that have been born in other hospitals and in some instances, ‘shared’ babies on behalf of
other responsible sites.
A daily list will be produced from CMIS of all babies born in the preceding day within the
hospital and home when a birth notification is completed. The national S4H database for
newborn hearing screening is electronically notified of all birth with production of an NHS
number and a list will be produced daily for all outstanding eligible babies.
The newborn will either enter the hearing screening pathway as a well baby or babies
resident in the NNU for more than 48 hours. See appendix 1 and 2
Screening for both well babies and NNU babies will be performed by the Newborn Hearing
Screening Team.
The screeners will approach all parents of eligible newborns and offer screening, ensuring
the availability of the screening booklet ‘screening tests for you and your baby’ in an
appropriate language. Screening tests for you and your baby can be accessed in other
languages via https://www.gov.uk/government/publications/screening-tests-for-you-and-
your-baby-description-in-brief
Alternatively the screener will access an interpreter via prestige network 01635 246700.
The parents will have received the ‘screening tests for you and your baby’ booklet at the
Author: Jo Young, Ali McMaster Date: April 2018
Job Title: Team Lead, Local Manager Review Date: April 2020
Protocol Lead: Group Director Urgent Care Version: 2.0 ratified 6/4/18
Location: Policy hub/ Clinical/Maternity/ Postnatal/ CG570
This document is valid only on date last printed Page 4 of 14
Newborn Hearing Screening protocol (CG570) April 2018
beginning of pregnancy and also discussed screening at the 34-36 week antenatal
appointment with their community midwife. Consent will be verbally gained as is nationally
accepted.
The aim is to carry out the offer of screen and the screen prior to discharge from hospital at
the bedside. If it is not possible to perform or gain consent prior to discharge an
appointment will be offered. An out-patient appointment will also be offered to the following
groups:
Babies born at home
Babies born in another hospital (if not already screened) if we are the responsible
site
Babies we are sharing and screening (when we are not the responsible site)
Initial contact will be made by phone offering an appointment. If unable to contact by
phone the following letters will be sent dependant on the situation –
- NBHS - First appt letter
- NBHS – OAE2 appt in clinic letter
- NBHS - SCBU missed appt
3.1 Well Babies
Screeners will perform a hearing screen following the well baby pathway. The initial
screen is called AOAE (Automated Otoacoustic Emission). The result will be - Clear
response/No Clear response/Incomplete test.
The terms Clear response and No Clear response is in line with National Hearing
Screening Programme (NHSP) as these terms are more family friendly than
pass/fail.
Clear response (CR) - Screeners will document in the personal child health record
book PCHR ‘red book’ the hearing test outcomes
No Clear response (NCR) - On 1st screen. Screeners will organise to return to
screen a minimum of 5 hours later explaining the potential reasons for a NCR and
an opportunity for parents to ask any questions. Parents may choose not to stay in
hospital to have 2nd AOAE and the screeners will organise an appointment for the
parents to return to hearing screening clinics being run throughout the week.
No Clear response (NCR) on 2nd test. Screeners will refer parents back to the
patient information leaflet ‘Screening Tests for You and Your Baby’. The AABR test
will either be performed immediately (depending on availability of a machine,
availability of screeners or suitability for baby to have the test) or following
Author: Jo Young, Ali McMaster Date: April 2018
Job Title: Team Lead, Local Manager Review Date: April 2020
Protocol Lead: Group Director Urgent Care Version: 2.0 ratified 6/4/18
Location: Policy hub/ Clinical/Maternity/ Postnatal/ CG570
This document is valid only on date last printed Page 5 of 14
Newborn Hearing Screening protocol (CG570) April 2018
agreement with the parents, the screener will organise an appointment for the
parents to return to the next, most convenient hearing screening out-patient clinic.
If there is No Clear Response from the AABR- The screeners will provide parents
with National Screening Committee leaflet, ‘Your Baby’s Visit to the Audiology Clinic’
and be responsible for organising a referral to audiology. Parents should be seen
within 4 weeks for the appointment. Screeners will document in the personal child
health record (PCHR) book ‘red book’ the hearing test outcomes
Targeted Follow up – Some conditions may results in the baby developing a
hearing loss after the screen has been completed. These babies, despite having
CR/CR at screening, should be offered a targeted follow-up appointment with
audiology at 7-9 months of age. Conditions include:
Craniofacial anomalies e.g. cleft palate
A syndrome associated with hearing loss e.g. Downs Syndrome
Congenital infection:- Rubella, CMV or toxoplasmosis
NICU baby with bilateral NCR at AOAE and bilateral CR at AABR
Screening Contraindications – Two groups of babies will be referred directly to
Audiology for a full diagnostic assessment WITHOUT screening as follows:
Microtia/atresia in one or both ears
Confirmed or strongly suspected bacterial meningitis or meningococcal
septicaemia
The screeners will upload screening outcomes preferably between each screen but
at a minimum daily to S4H, the National Newborn Hearing Screening database.
At the end of each day the screeners are responsible for setting ‘outcomes’ of each
screened newborn on the national database (including any ‘incomplete’ screening
outcomes). This allows for recognition of outstanding hearing screens and failsafe’s
to be actioned to ensure no baby is missed the offer and acceptance or decline of
newborn hearing screen.
If parents decline hearing screening then they will be signposted to the PCHR for
checklists they can carry out to monitor their baby’s’ hearing. The screener will be
responsible for giving a decline letter to the parents and notifying their GP (in the
letter will be details of how the parents can contact the screening team if they
change their mind). The HV will be aware of parents declining Newborn Hearing
Screening as it will be documented in the PCHR (see Appendix 3).
Author: Jo Young, Ali McMaster Date: April 2018
Job Title: Team Lead, Local Manager Review Date: April 2020
Protocol Lead: Group Director Urgent Care Version: 2.0 ratified 6/4/18
Location: Policy hub/ Clinical/Maternity/ Postnatal/ CG570
This document is valid only on date last printed Page 6 of 14
Newborn Hearing Screening protocol (CG570) April 2018
The Local Manager for the Newborn Hearing Screening Team is responsible for
performing a weekly search on S4H to ensure all babies requiring referral to
Audiology (immediate and targeted) have an appointment.
Local infection policies will be followed
3.2 NICU Babies
In instances where the baby has been in NICU for a period of > 48 hours, screeners will perform a hearing screen following the NICU/SCBU baby pathway (see Appendix 2) once the baby is well enough and over 34 weeks gestation. Screening of NICU babies will only be carried out after the ‘NICU NHSP Risk Factor’ sheet has been completed by a Paediatrician.
3.3 Baby born out of area
The Screening local manager will be responsible for ensuring babies the RBH is
responsible for, but are born in other hospitals, have completed the screen (transfer
ins). Completed means result of CR/NCR with referral/Decline or NCR with decline
of referral. The local manager achieves this by using S4H to provide a list of babies
that require a Newborn Hearing Screen. The Local Manager will ensure that if the
baby was born in a hospital other than RBH that an ‘outcome’ has been set. If there
is no outcome set it will be the Local Managers responsibility to request that this
information is added by the screening site. Excellent pathways of communication will
be fostered between hospital sites to greater improve offer rates. The Local Manager
will also monitor share in and share out of newborns to ensure screen has been
completed or is offered.
3.4 Babies Moving in to the Area
The Hospital based screening programme is responsible for babies up to 12 weeks
of age. CHIS will provide a monthly list of all babies moving in to the cohort area. If
not already carried out elsewhere, the Local Manager will be responsible for
ensuring screening is offered. The case will be closed when appropriate
investigations have confirmed that screening has already taken place and no follow-
up is required by our site or the parents have been offered the screen with an
outcome or declined the screen.
3.5 Deceased Babies
CHIS are responsible for the timely notification, via email, to the newborn hearing team of any infant deaths in the area. The Local Manager is responsible for ensuring that these emails are checked daily and that S4H is updated accordingly and without delay.
Author: Jo Young, Ali McMaster Date: April 2018
Job Title: Team Lead, Local Manager Review Date: April 2020
Protocol Lead: Group Director Urgent Care Version: 2.0 ratified 6/4/18
Location: Policy hub/ Clinical/Maternity/ Postnatal/ CG570
This document is valid only on date last printed Page 7 of 14
Newborn Hearing Screening protocol (CG570) April 2018
3.6 DNA for Newborn Hearing Screening Appointments
The Newborn Hearing Screening Programme follows the Trusts’ DNA policy. The
following letters will be sent dependant on the stage of screening.
- Missed Appointment Letter
- Missed Appointment – Bilateral Letter
- Missed Appointment – Unilateral Letter
- Missed Appointment GP Letter
The Health Visitor will be made aware of this as incomplete form in PCHR record.
3.7 Equipment QA Checks
Newborn hearing screeners are responsible for personally completeing the required daily QA checks on all screening equipment that they use, as detailed in the NHSP Operational Guidance 5. Equipment, paragraph 7.1 Equipment Quality Assurance (QA) Checks. The results of these checks are entered into the appropriate log and if there are any concerns about the results not being as expected, the equipment must not be used and the matter must be referred to the LM.
3.8 Record Retention
Paper copies of patient ‘proformas’ will be retained in the NHSP Local Manager’s
Office for a period of 12 months, after which, they will be destroyed.
4.0 Roles and Responsibilities
The screening team is structured with a Team Leader who is strategic lead for the
local programme. They have clinical and professional responsibility for the overall
running of the programme.
The NHSP Local Manager (formally known as the Local Co-ordinator) is the
operational lead for the local NHS Newborn Hearing Screening Programme and is
responsible for the day to day management of all aspects of the programme and staff.
This includes ensuring protocols for the screening programme are adhered to and
dissemination of National Screening Programme updates in to clinical practice.
The NHSP Screener works as a member of a team participating in the hearing
screening of newborn babies, under the supervision of the NHSP Local Manager. The
NHSP screener role involves the gathering and accurate recording of clinical and test
data relevant to the screening process. The role also involves direct handling of
newborn babies and contact with parents.
Author: Jo Young, Ali McMaster Date: April 2018
Job Title: Team Lead, Local Manager Review Date: April 2020
Protocol Lead: Group Director Urgent Care Version: 2.0 ratified 6/4/18
Location: Policy hub/ Clinical/Maternity/ Postnatal/ CG570
This document is valid only on date last printed Page 8 of 14
Newborn Hearing Screening protocol (CG570) April 2018
5.0 Consultation Undertaken PHE National newborn hearing programme
RBH has undertaken the role of ensuring newborn hearing screens are performed to
the eligible population. Service specifications were agreed between Public Health
England and RBH. The service is to be provided as a hospital based service, with a
dedicated team of staff. Accommodation has been provided in the relevant settings to
enable good quality screening to take place. Stakeholders include NHS Public Health
England, Head of Midwifery, NHSP Screeners, GP’s, Neonatal Unit and Health
Visitors.
6.0 Dissemination/Circulation/Archiving
This protocol will be published on the Maternity Intranet site and will be available for
all Trust employees. In addition, service users and GPs can access the site via the
Intranet.
Staff involved in Newborn Hearing Screening will regularly be updated and
monitored in compliance with NHSP standards.
7.0 Training
All newborn hearing screeners must have undertaken and achieved Objective
Structured Clinical Examination (OSCE) qualification.
Training required to fulfil this protocol will be provided in accordance with the Trust’s
Training Needs Analysis. Management and monitoring of training will be in
accordance with the Trust’s Learning and Development Protocol. This information
can be accessed via the Learning and Development pages on the Trust intranet.
CPD will be undertaken and achieved by all newborn hearing screeners, in
accordance with the NHSP Operational Guidance 2. Training, paragraph 3
Established Screener.
8.0 Monitoring of Compliance
Set out how you will monitor compliance with the document. The table below should
be completed - only include what is feasible and what you will actually do – not what
you think should be done.
Author: Jo Young, Ali McMaster Date: April 2018
Job Title: Team Lead, Local Manager Review Date: April 2020
Protocol Lead: Group Director Urgent Care Version: 2.0 ratified 6/4/18
Location: Policy hub/ Clinical/Maternity/ Postnatal/ CG570
This document is valid only on date last printed Page 9 of 14
Newborn Hearing Screening protocol (CG570) April 2018
Aspect of compliance or effectiveness being monitored
Monitoring method
Individual or dept. responsible for the monitoring
Frequency of the monitoring activity
Group/committee which will receive the findings/ monitoring report
Committee/ individual responsible for ensuring that the actions are completed
Daily cohort S4H/CMIS LM daily NHSP/S4H LM/TL
Transfers in and Out
S4H LM daily
LM LM/TL
Discrepant Data Reports
S4H National Team/Local Manager
monthly LM LM/TL
Audiology Appointment Search
S4H LM Weekly LM LM/TL
Missing results search
S4H LM Weekly LM LM/TL
Yield Report National Team S4H
National Team/Local Manager
monthly LM LM/TL
Patient Survey Survey LM Weekly LM LM/TL
KPI’s S4H National Team/Local Manager
Quarterly NHS Public Health England, Trust Board and Head of Midwifery and LANNBSG
LM/TL and chair of the LANNBSG and Head of Midwifery
Individual screener report
National Team S4H
National Team/Local Manager
monthly LM LM/TL
Annual Report National Screening Committee
Local Manager
Yearly NHS Public Health England, Trust Board and Head of Midwifery LANNBSG and NSC
Head of midwifery
Parents receiving written and verbal information/ survey/LM/Yearly/Team lead
Offer of screen/KPI+S4H/LM/daily+quarterly/LM PHE+S4H/Team lead
Completion of screen/S4H/LM/Daily+monthly/LM PHE +S4H/Team lead
The Trust reserves the right to amend its monitoring requirements in order to meet the changing needs of the organisation. **Some tasks may be delegated by the LM to members of the newborn hearing screening team, if deemed appropriate **S4H is the current national database, however the previous national database, eSP is still in use for historical cases. It is expected that eSP will be decommissioned in early 2018.
Author: Jo Young, Ali McMaster Date: April 2018
Job Title: Team Lead, Local Manager Review Date: April 2020
Protocol Lead: Group Director Urgent Care Version: 2.0 ratified 6/4/18
Location: Policy hub/ Clinical/Maternity/ Postnatal/ CG570
This document is valid only on date last printed Page 10 of 14
Newborn Hearing Screening protocol (CG570) April 2018
9.0 Supporting Documentation and References
9.1 NHSP Contacts
Contact Number
Newborn Hearing Screening Office 0118 322 7556
Newborn Hearing Screening mobile 0774 818 1174
Newborn Hearing Screening email [email protected]
Jo Young Team Leader [email protected]
Audiology 0118 322 7238
Child Health Information Services 0207 004 1501
Author: Jo Young, Ali McMaster Date: April 2018
Job Title: Team Lead, Local Manager Review Date: April 2020
Protocol Lead: Group Director Urgent Care Version: 2.0 ratified 6/4/18
Location: Policy hub/ Clinical/Maternity/ Postnatal/ CG570
This document is valid only on date last printed Page 11 of 14
Newborn Hearing Screening protocol (CG570) April 2018
Appendix 1 - Well baby Protocol
https://www.gov.uk/government/publications/newborn-hearing-screening-care-pathways
Author: Jo Young, Ali McMaster Date: April 2018
Job Title: Team Lead, Local Manager Review Date: April 2020
Protocol Lead: Group Director Urgent Care Version: 2.0 ratified 6/4/18
Location: Policy hub/ Clinical/Maternity/ Postnatal/ CG570
This document is valid only on date last printed Page 12 of 14
Newborn Hearing Screening protocol (CG570) April 2018
Appendix 2 - Newborn hearing screening NICU or NNU Protocol
https://www.gov.uk/government/publications/newborn-hearing-screening-care-pathways
Author: Jo Young, Ali McMaster Date: April 2018
Job Title: Team Lead, Local Manager Review Date: April 2020
Protocol Lead: Group Director Urgent Care Version: 2.0 ratified 6/4/18
Location: Policy hub/ Clinical/Maternity/ Postnatal/ CG570
This document is valid only on date last printed Page 13 of 14
Newborn Hearing Screening protocol (CG570) April 2018
Appendix 3 Decline of screening- well baby
Author: Jo Young, Ali McMaster Date: April 2018
Job Title: Team Lead, Local Manager Review Date: April 2020
Protocol Lead: Group Director Urgent Care Version: 2.0 ratified 6/4/18
Location: Policy hub/ Clinical/Maternity/ Postnatal/ CG570
This document is valid only on date last printed Page 14 of 14
Newborn Hearing Screening protocol (CG570) April 2018