171: Implementation of A Simplified Pulse Oximetry Screening Program

Newborn pulse oximetry screening increases detection of critical congenital heart disease otherwise missed by antenatal ultrasound and physical examination. The AAP endorsed a protocol checking oxygen saturations in the right hand and one foot at ≥24 h of age, with abnormal results (<95%) subject to repeat screening. We describe our experience in implementing a simplified protocol at a Canadian tertiary children's hospital and a referring regional hospital. We collected information from the screening program organizers. Cardiology chose a simplified screening protocol, checking oxygen saturations in one foot between 24 h and 36 h of age. This was supported by a meta-analysis indicating no significant differences in sensitivity or false positive rates compared to checking both foot and right hand (Thangaratinam, Lancet 2012). A single abnormal saturation (<95%) requires physician assessment. If the low saturation is confirmed and no other cause identified, an echocardiogram would be arranged within 24 h (utilizing telemedicine at the regional hospital). Physicians and nurses welcomed more ways to improve detection of CHD. Screening was started in February 2013 in the post partum unit at the tertiary hospital (approximately 4500 neonatal admissions annually) and in July 2013 at the regional hospital (approximately 900 annually). As of December 2013, there have been no positive screens. All cardiac surgery in the region comes to the tertiary hospital; we are aware of no false negative results. Education was delivered at a staff meeting followed by individual teaching as required, and a written protocol was distributed. As nurses were familiar with pulse oximetry, education focused on teaching the protocol. Reusable oximetry probes and probe wraps were used. Three dedicated oximeter machines were adequate for the tertiary unit and one was used at the regional site. Testing was usually done at bath time. We estimate it takes 10 minutes to do the screen, clean the probe and document. A selective chart review showed excellent compliance, but inconsistency in where results were being documented. Newborns discharged from the birthing unit and home births were not being screened. Our experience shows that a pulse oximetry screening program can be readily implemented. There are areas for improvement in documentation, and we identified groups to target for screening. We believe the simplified protocol and shifting the management of abnormal screens to the physician allowed for easier implementation.

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