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Do You Know Who's at Risk? Screening for Critical Congenital Heart Disease Using Pulse Oximetry

Newborn Care Poster Presentation Purpose for the Program Congenital heart disease (CHD) is a common birth defect that affects approximately 8 of every 1,000 infants. Infants with critical CHD may appear asymptomatic during the first few days of life. Timely diagnosis of this disease is critical to the well‐being of these infants. Early detection of critical CHD can help improve the prognosis and decrease both the morbidity and mortality rates of affected infants. What is the best approach to implementing a practice change in a large community academic teaching center? Proposed Change To implement bedside screening for infants with critical CHD using pulse oximetry. Following the recommendations of the American Academy of Pediatrics and the American Heart Association, a multidisciplinary team at a level III hospital convened to determine the best way to implement a critical CHD screening program. A review of the literature identified pulse oximetry as a useful screening tool for critical CHD. Pulse oximetry is noninvasive, readily available, cost‐effective, and can be performed by the bedside nurse. Used in conjunction with the physical examination, pulse oximetry can help identify infants who may require further evaluation. Implementation, Outcomes, and Evaluation The implementation process and education process for our practice change began in January 2012. A timeline was presented to outline our implementation process that included policy development, staff education, a time management pilot, and documentation changes. In February, we began the pilot to screen infants between 24 hours of age and 28 hours of age. At the conclusion of the 3‐month pilot, over 1,200 infants were screened for critical CHD. Three infants were identified as "at risk" and required additional evaluation and follow‐up. Challenges and barriers often present themselves when implementing a practice change. Sharing those opportunities can be an educational process for others. For example, our pulse oximetry equipment led to the decision to perform oxygen saturation readings in direct sequence as opposed to parallel readings. Improved communication between nurses and physicians led to the development of a follow‐up evaluation process and improved electronic documentation. Implications for Nursing Practice Our program was strengthened by the use of an algorithm that guided the clinical decision‐making process when screening results were analyzed. Education and practice sessions reinforced staff awareness and skills required to perform critical CHD screening. Ongoing evaluation allows us to assess the value of our process and implement change when necessary to improve our program.