Authors (including presenting author) :
Hung GKZ, Ha G, Lam S, Cheung TF, Leung KW, Belaramani K, Wong MSR
Affiliation :
(1)Department of Paediatrics, Hong Kong Children Hospital
Introduction :
Expanded territory-wide newborn screening program for inborn errors of metabolism (NBSIEM) has been implemented since October 2020. Infants requiring transfer to the HKCH require follow-up to ensure that the NBSIEM programme is completed despite leaving birthing hospital. The timing of when to take these first and second NBS samples may be confusing especially for non-neonatal nurses. Other newborn screening programmes also needs to be completed before the patient is discharged from hospital. Stakeholders requested a system and workflow that would enable all users to keep track of completion and statuses of the newborn screening programmes as mentioned.
Objectives :
To design and implement a single electronic-Newborn Screening Record for all infants admitted to Hong Kong Children’s Hospital from other regional hospitals. The e-Newborn Screening Record needs to be integrated amongst the three different CIS layouts (PICU, NICU, and Cardiac). It documents the status of blood taking for the region-wide NBSIEM program, hypothyroid and G6PD deficiency screening, and hearing screening. It should facilitate nurses who are unfamiliar for newborn screening to take appropriate follow-up actions by being user-friendly with suggested actions. The objective is to minimize miscommunication of the statuses of newborn screening program when transferring the patient between wards, to simplify the workflow of completing the newborn screening program, and closing the loop of communication between the Metabolic Nurse and ward nurses.
Methodology :
The NICU CIS team and metabolic team collaborated to create a workflow and e-Newborn Screening Record. Other stakeholders including the PICU and Cardiac nursing team were also involved.
The Newborn Screening Record is split into 4 main sections:
(1) G6PD and Thyroid Function Sampling Record
(2) NBSIEM Record
(3) Hearing Screening Record
(4) A linked form for Metabolic nurse to document further instructions for ward nurse as well as a checkbox to document that the NBS screening is complete
Feedback from nursing and metabolic nurses was invited after implementation. Adherence to correct sampling of NBSIEM bloods was audited.
Result & Outcome :
The e-Newborn Screening Record was implemented since early 2021. The e-Newborn Screening Record was noted by users to be easy to use, with clear blood-taking instructions and communication of completion of newborn screening programs achieved. The e-Newborn Screening Record is the only electronic form in the CIS system at HKCH that follows the patient through the entire CIS inpatient journey. This reduces transcribing and documentation errors and facilitates handover. Of 173 neonates requiring follow-up: 11/12 (91%) of pre-transfusion samples, 173/173 (100%) of 1st NBS sample and 110/110 (100%) of 2nd NBS samples were taken correctly. It is proposed that in the future, a cross-cluster electronic Newborn Screening Record document can be designed as part of the Hospital Authority’s IT Initiatives to be accessible through Clinical Management System (CMS) and hence not needing to rely on the restricted local CIS system.
