Newborn Hearing screening guideline (GL1106)

Transcription

1 Newborn Hearing screening guideline (GL1106) Approval Approval Group Job Title, Chair of Committee Date Maternity & Children s Services Clinical Governance Committee Chair, Maternity Clinical Governance Committee 4 th May 2018 Change History Version Date Author, job title Reason /04/18 Ali McMasters, Local Manager Newborn Hearing Screening Programme Trust requirement This document should be read in conjunction with the following: Newborn Hearing Screening Protocol (CG570) MAT-SOP003 KPI data to UKNSC standard operating procedure Job Title: Local Mgr Newborn hearing screening services Review May 2020 Date: Policy hub/ Clinical/ Maternity / Postnatal / GL1106 This document is valid only on date last printed Page 1 of 16

2 Contents 1. Equipment QA Checks Consent Types of Screen Clinic Bookings Transfers and Shares Deceased Babies Movement In (To Area) Babies SCBU Babies Monitoring and Screening This document is valid only on date last printed Page 2 of 16

3 1. Equipment QA Checks There are a series of visual checks, probe checks and QA checks designed to identify faults or problems with the equipment. They must all be performed by the individual screener who will be using that specific piece of equipment before it is used to screen any babies. If the equipment fails any of the checks it must be removed from service until the fault is investigated and rectified. In some instance, it may be appropriate to repeat the check, for example repeating a real ear check if background noise occurs midway through the check. Failure to carry out and save these checks correctly can compromise the efficacy of the screen and in some cases it may be necessary to recall babies. All checks are recorded on an electronic log sheet for each individual piece of equipment - these log sheets are to be retained for auditing purposes see excel spread sheet entitled DAILY EQUIPMENT CHECKS. It is important to note any repeat QA checks with reasons, as well as recording anything out for the ordinary or equipment faults in the comments section as they occur. The QA checks results are uploaded into the national IT system (S4H) with the screening results and the Local Manager is responsible for regularly checking that QA tests are being appropriately completed. QA test Description Correct outcome Notes QA 1 (Cavity) NCR/cavity OK AOAE QA 2 (occlusion) AOAE QA 3 (real ear) AOAE QA 4 (Click) AABR Visual check AOAE and AABR Probe check AOAE Probe is placed in a cavity. Checks for artefacts which could be misinterpreted as a response in a real ear. Performed to ensure that the equipment could detect a deaf ear. Ear piece is occluded. Checks earpiece and cover are correctly assembled Detects a clear response from a hearing ear Checks both speakers are emitting stimulus and electrode connectivity Overall condition of equipment looking for damage/cracks/weak or worn parts Checks the speaker and microphone are working correctly NCR/Occlusion OK CR/real ear OK. In the absence of anyone who usually has CR their usual expected result is acceptable Stimulus (clicks) can be heard/recorded If CR this equipment would not refer a baby with PCHI Any babies screened following a QA1 CR and discharged on that screening result will need to be recalled If ear piece not assembled correctly equipment could refer babies unnecessarily Checks equipment can correctly detect a CR if not could refer babies unnecessarily If clicks are not emitted, or electrode connectivity is poor equipment could refer babies unnecessarily. May affect equipment performance This document is valid only on date last printed Page 3 of 16 N/A Pass/probe OK If stimulus level is too low or the microphone is not picking up the stimulus could refer babies unnecessarily

4 2. Consent A friendly, professional and structured approach to gaining consent ensures that parents are fully engaged in the process and that all information is covered. An interpreter or interpreter services (over the telephone) can be used if necessary. Interpreting service details can be found on the intranet at: Consent must be taken from the person with parental responsibility for baby; this is usually the birth mother. If the baby has been taken in the care of the Local Authority, parental responsibility is usually shared between the birth parents and the Local Authority. In such cases, contact the maternity safeguarding midwife team (Amanda Shearer & Catherine Eccles) on or rbft.matsafeguarding@nhs.net for contact details of the named Social Worker, to ensure that consent is obtained from the appropriate person. Always introduce yourself by name and explain that you are here to talk about the newborn hearing screen. Ensure that it is a convenient time to talk and that you have the correct mother before proceeding. Provide a detailed explanation about the screen and what it will involve (covering the entire process). Remember that screening is offered and there must be no pressure to have it. Obtain information about risk factors and ensure that an explanation about how the data will be stored and who has access to it is given. If mum is not agreeable to the information storage, you CANNOT proceed with the screen. If mum gives consent, screening can go ahead. If following your consent discussion that a mother wishes to decline the screen you must: Ask mother to complete and sign a copy of the decline form Advise mother that she can continue to monitor baby s hearing by referring to the checklists in the PCHR (red book) Give mother a copy of the decline letter, which includes contact details if she changes her mind File the completed decline form in the Decline Form File Send the decline letter to baby s GP to inform them that screening has been declined/not done Set outcome on S4H to incomplete screen declined Add a detailed case note on S4H to note information that was given verbally to mother and her response, to document that a decline form was signed and that mother was given and GP was sent a copy of the decline letter (the programme This document is valid only on date last printed Page 4 of 16

5 must be able to prove that sufficient information was provided if the child is subsequently diagnosed with a hearing loss and there is any suggestion that the screen was not offered). 3. Types of Screen We can conduct 2 different screens; the automated otoacoustic emission (AOAE) and the automoated audiory brainstem response (AABR). Although there is other equipment available, we currenlty use different machines for each type of screen: Automated Otoacoustic Emission (AOAE) Carried out using the Otoport Automated Auditory Brainstem Response (AABR) Carried out using the Algo 3i Objective screening allows us to gain information from babies and very young children without them having to respond behaviourally. 3.1 AOAE Patient data is entered into the Otoport and after observing the ear canal to ensure it is patent and assess the size, an appropriate sized ear tip is selected by the screener. The largest tip that fits comfortably in the ear should be used in order to minimise noise and maximise emissions. The tip is attached to the probe and inserted into the baby s ear ensuring a snug fit and securing with a quarter turn. Once the fit is established, the leads are up and away from baby and the environmental factors are conducive, the screen can begin The machine sends soft clicks (about 30dB which is the level of quiet speech) to the cochlea in the inner ear. If all is well, the hair like cells in the cochlea will move in response the clicks and create and echo which is picked up by the microphone in the probe. The machine then provides a result of clear response (CR) or no clear response (NCR). NCR can be due to: Fluid or debris still present in the ear canal following the birth, baby becomes unsettled during screen, environment becomes noisy during screen or a hearing loss This document is valid only on date last printed Page 5 of 16

6 This process is repeated on both ears and the appropriate paperwork completed to accurately record the outcome and other relevant information, such as risk factors If necessary, e.g. screening conditions deteriorate, the screen can be paused midway, but if the earpiece is removed or falls out, the screen must be incompleted. It is possible to refit the earpiece up to 3 times. It is not appropriate to refit the earpiece if the baby is unsettled or the environment is noisy wait until conditions are more suitable Downloading from the Otoport Screeners must download the data from their equipment to S4H (via our intermediate software Otolink) when they have completed their screens for the day. The system then matches this data to the correct patient record and the screener can set outcomes etc. Ensure the Otoport is switched OFF Connect Otoport to designated PC or laptop using cable provided. OTOLINK will open automatically in the computer. Note how many screens and patients are recorded. Is this correct? Synchronise the computer and Otoport Date and Time using the green arrow button Press download button Successful download is confirmed by number of screens and patients is 0 and a confirmation of successful data transfer. Disconnect the Otoport. It is now empty and ready to use again If download is not successful then you will see a message cannot establish a connection with S4H web services. When you receive this message the data you have transferred will be removed from your Otoport and will be found on the software on your PC. To view this data you will need to DOUBLE LEFT click on the DATA VIEWER icon on your desktop. Results of the screens you have attempted to download will be stored here until the next time you download from the same computer when the data should be automatically uploaded. If you are having trouble downloading please contact IT and note the PC asset number that you attempted to download on. To check your Otoport after an unsuccessful download: GO to RECORDS menu on the OTOPORT and select This document is valid only on date last printed Page 6 of 16

7 Find SUMMARY which should show you PATIENTS 0 RECORDS 0 If data is still on your OTOPORT try downloading again on your PC Maintenance and Cleaning of Otoports The Otoports must be returned to Otodynamics for calibration every 3 years. In addition, the battery must be reconditioned (fully drained and then recharged) every year see Otoport Log for Machines Jan 18 for details. The Otoport is robustly constructed but is a precision instrument so should be handled with care Ear Tips The ear tips are disposable and should be discarded after each baby is screened. The same ear tip can be used for both ears unless there is fluid or debris present, if the screen is painful - consider infection and prevent cross contamination, or if a different sized tip is required for each ear Probe The probe is a precision assembly and care should be taken throughout in its handling and cleaning. The casing should be cleaned with a Clinell wipe before screening begins in the morning and subsequently, after each baby is screened and left to dry taking care that no moisture gets into the tubes (couplers). If debris or moisture gets into the couplers they must be replaced and the Otoport re-calibrated before using for any further screening. Couplers tubes should be changed at regular intervals (i.e. least every 3 months) to prevent contamination The casing should be replaced if contaminated Cable and Instrument The Cable may be cleaned with a Clinell wipe (from the patient end down). The cable should be cleaned with a Clinell wipe before screening begins in the morning and subsequently, after each baby is screened and left to dry This document is valid only on date last printed Page 7 of 16

8 The Otoport itself should not come into contact with the patient being screened but should be cleaned before screening begins in the morning and subsequently, after each baby is screened using a Clinell wipe. Do not allow liquid to enter the Otoport and do not immerse in fluid. The cable and ear piece should be kept loosely coiled attached to the Otoport when not in use to reduce the risk of dust or damage to the couplers How to Change a Coupler Equipment required Remove lid from body Hold lead on flat surface and push body down Remove and dispose of Attach new couplers Align couplers and old couplers replace body carefully Re-attach lid to body Press lid firmly to secure NOW CALIBRATE THE MACHINE before using it for screening again. Record the coupler change and calibration checks on the Otoport QA Test Log 3.2 AABR Not all babies will require an AABR The machine is calibrated to screen babies >34 weeks gestation. This document is valid only on date last printed Page 8 of 16

9 Baby must be asleep or settled and this screen can take up to 20 mins. Patient data is entered into the Algo3i and disposable earphones (red for right and blue for left) are placed of the baby s ears and sensors are placed on the nape of the neck (white), shoulder (green) and forehead (black). Ensure there is more than a 2cm gap between the nape and shoulder sensors. Good skin preparation with sufficient prep gel prior to sensor placement (particularly on the forehead) ensures that impendence levels remain low and similar. Once the earphones and sensors are in place and the environmental factors are conducive, the screen can begin. It is possible to pause the screen if screen conditions deteriorate temporarily and then carry on when conditions improve. If not complete results are obtained on one or both ears, one further AABR screen can be carried out. The machine sends a soft click stimulus at 35 or 40 db and each click evokes a series of identifiable brain waves from the auditory brainstem. Each click coupled with a response to that click is called a "sweep". If a REFER result is obtained, the screener will refer baby to Audiology for diagnostic testing Downloading from the Algo 3i Screeners must download the data from their equipment to S4H (via our intermediate software Audible for MRC) when they have completed their screens for the day. The system then matches this data to the correct patient record and the screener can set outcomes etc. Turn Algo on (login) Data management (ok) Synchronize with PC (ok) Go to desk MRC (on desk top) Sign in (rbh_******) password (1****6) Go to first icon (device data import) Select device (A3i) Get infrared ready and line up with window on the left side of Algo press next on desktop the quickly press ok on Algo (they will now connect to each other) Algo will now transfer data to desktop Go to second icon at the top (transmit screen to S4H) This document is valid only on date last printed Page 9 of 16

10 Select and press start (please make sure all data has transferred and fail count is 0 if not please report to the Band 4 or Local Manager) This is now complete close everything down and set outcomes on S4H Maintenance and Cleaning of the Algo3i The PCA cables, which attach to the Algo 3is must be returned to HC Life Ltd for calibration every year see Algo Log for Machines Jan 18 calibration for details. The Algo 3i is robustly constructed but is a precision instrument so should be handled with care Ear phones The earphones are disposable and should be discarded after each baby is screened Sensors The sensors are disposable and should be discarded after each baby is screened Cable and Instrument The Cable may be cleaned each day before a screening session, and after each baby has been screened with a Clinell wipe (from the patient end down). The Algo 3i itself should not come into contact with the patient being screened but should be cleaned each day before a screening session, and after each baby has been screened using a Clinell wipe. The cable and ear piece should be kept loosely coiled attached to the Otoport when not in use to reduce the risk of dust or damage to the couplers. 4. Clinic Bookings As well as screening on the maternity wards, out-patient clinics are held at the Royal Berks, the West Berks Community Hospital in Newbury and Wokingham Hospital. 4.1 How to make clinic bookings Log onto S4H Check each new proforma as below: o If baby has already been screened discard o If baby lives outside of Wokingham/Reading/Newbury write transfer out on proforma and pass to Heather o If baby has been on NICU for > 48 hrs note the time admitted and discharged from SBCU on the proforma (this information can be obtained This document is valid only on date last printed Page 10 of 16

11 Ask parents to: from BADGER) and put in NICU file. Get risk factor sheet completed by Paediatrician ASAP. o If baby is being shared out pass to Band 4 or Local Manager o If baby already has an appointment, double check details are correct and file in the appropriate clinic folder Call parents to book appointment Put proforma in date order oldest first Contact patients in order of those closest to going out of remit first Always ensure appointment is within term + 4 weeks (as indicated on S4H) if not alert Band 4 or Local Manager immediately Come to xxx (provide relevant details for other clinic sites as appropriate) Bring the baby s red book, arrive on time and bring change and feed if bottle feeding (allowing sufficient time for parking if driving) Advise them that the screen is much easier when baby is settled and asleep Ask them to let us know if they are unable to attend Note appointment details on S4H and clinic e-calendar and file proforma in relevant clinic folder **The afternoon before your clinic, please contact all parents for the following day s clinic as a courtesy reminder and to ensure they are still able to attend** 4.2 Did Not Attend (DNA) If you are having difficulty contacting parents please follow this process: o Try to contact by telephone 2/3 times o If you are unable to contact via telephone, make an appointment and send a letter letting them know when it is o All attempts to contact MUST be added as a case note to S4H If they DNA appointment offer another and send them a letter/document on S4H If they DNA the 2nd appointment S4H record should be set to appointments missed if they have not had any screening at all. If they have had 1st OAE it should be set to withdrew consent. Send an appointments missed letter to the parents Send a notification letter to alert HV/GP This document is valid only on date last printed Page 11 of 16

12 5. Transfers and Shares 5.1 Transfer in Check DOB to ensure it is a recent birth. If it isn t, check case notes to find out why the late transfer. Also check baby has had necessary screening and if not arrange o/p appointment for screening (if less that 4 weeks corrected) or a referral to Audiology if over 12 weeks of age. Check the Gestation if it is low and you think it may be a SCBU baby but transferring site have not changed protocol or shared the record, query with them before transferring in. If any babies appear on the transfer in list with a low birth weight or GA and no associated case notes, double check with the Manager of the site that are transferring in to us to ensure that baby is well and has been discharged before contacting the parents (we do not want to contact parents of deceased babies). Check baby lives in our area and is registered with one of our GP s If it isn t you need to query with the transferring site why the record was sent to us (check case notes first). Check if baby is marked as NICU. If it is, is it being shared with the transferring site? If it isn t being shared, is the baby with us or has baby been discharged home? Check our SCBU or if discharged and not been screened arrange an o/p appointment. Print proforma for all babies that have not had a hearing screen, or have an incomplete screen and put them in the appointment bookings folder and add a case note on S4H to say in RBH folder. If baby has been screened, but requires a referral to Audiology, check which site is providing the Audiology service and where appropriate, ensure you make the referral and add a case note to explain what you have done. **ALWAYS add case notes to document everything you have done** 5.2 Share In These babies are the responsibility of another site, for whom we are providing the screening service Check GP and Address to make sure they look correct. For example if you have a baby that lives in Reading but the GP is in Southampton, it is probably wrong and should not go to the suggested sharing site (find the correct GP and change it on S4H). Check screening status. If baby needs a referral to Audiology, notify the responsible site prior to breaking the share so that they are aware and can deal with the referral (add a case note to explain what you have done and who you informed about the referral). If parents prefer to be seen by RBH Audiology, add a case note to reflect this and maintain the share/let RBH Audiology decide whether they can accommodate. This document is valid only on date last printed Page 12 of 16

13 5.3 Breaking Shares Check CMIS to see if baby is still an inpatient if they are still an inpatient, add a case note to say checked CMIS still on Marsh/Iffley ward. Do not end share **remember baby may have gone to SCBU** If baby has been discharged and we don t have any results sat in the imported files to be allocated to the record you can end share. (Add case note to say checked CIMIS and baby discharged) If baby is in NICU click transfer and share option in S4H and set RBH as the temporary hearing screening provider 5.4 Share outs Always make sure the baby is well and alive at the point of ending a share and ensure the case note you write shows that you have made the necessary checks before transferring the record. These are our babies that are being temporarily looked after/screened by another site. Monitor this queue regularly check for case notes to see if they have said they will be screening baby If no case note after a few days and the site keeps the share you will need to make contact with the Local Manager for that Site to ask them if they are doing the hearing screening for that baby if they are they need to add a case note with details and if they are not, they need to break the share so that we can offer an appointment asap. 6. Deceased Babies Any babies that die after they have been discharged from hospital will still have an active record on S4H. They baby may have been part-way through the screening process and therefore it is ESSENTIAL that we are made aware of any such babies ASAP. We do NOT ever want to be in a position where a screener has contacted the parents of a deceased baby to make an o/p appointment by mistake. Child Health send an to our generic inbox, providing the NHS number and date of death for any deceased babies. Once this notification has been received, the allocated screener must deactivate the S4H record immediately, marking the baby as deceased and adding a case note with the associated information. The allocated screener must check to determine if any o/p appointments have been made and cancel any such appointments to ensure parents are not contacted in error. This document is valid only on date last printed Page 13 of 16

14 7. Movement In (To Area) Babies We need to confirm that all babies that move in to our responsible area have had a hearing screen that is complete and satisfactory. Any baby moving into our area that is less than 3 months of age should be offered the newborn hearing screen. Report supplied by Child Heath Login to S4H Select National Search Look up each NHS number on the Child Health Report Check to see if there are results on S4H Populate excel spread sheet in movement in searches e-folder accordingly If the results are there and the screen is complete cross off of the list and move on to the next. If no record exists you will need to log on to RIO/CAREPLUS and look for notes or any evidence that the baby has already had a hearing screen. If you cannot find anything you will need to call the parents/hv to find out if they have had a screen before they moved in. If baby has been screened abroad and have supporting documents, please add appropriate case note to S4H. If documentation indicates there was CR/CR and there are no hearing related risk factors we can record results on the report supplied by Child Health which will be filed and kept. If there is no supporting documentation, please offer our NHSP screen. If baby has been screened abroad, but the outcome was NCR, a record will need to be created on S4H and you will need to inform Audiology that baby needs to be seen by them and let them know it is a movement in baby. If baby hasn t been screened and they are UNDER 12 weeks, you will need to offer mum the screen. A new S4H record will need to be created in order for you to add the results. To create a new record you will need the following information baby s D.O.B, NHS number, birth time, birth weight, mums name, address, contact number and GP. Add patient records and upload results as you normally would. If the NHSP screen is declined, you do NOT need to complete a decline form simply add a case note on S4H and set the outcome accordingly. If baby hasn t been screened and they are OVER 12 weeks but UNDER 1 year It is down to the Health Visitor (you can find their details on RIO/CAREPLUS) to refer to Audiology please the HV accordingly and make a note on the spread sheet that you have done this. If baby hasn t been screened and they are over 1 year YOU DON T NEED TO DO ANYTHING. The HV will refer at their own discretion in this instance. This document is valid only on date last printed Page 14 of 16

15 8. SCBU Babies Monitoring and Screening 8.1 Daily Monitoring and Screening 8.2 S4H A member of the screening team must go up to SCBU every day and check all of the babies in all of the rooms, cross checking with proforma from the SCBU baby proforma file If you have a proforma for a baby that is no longer in SCBU find out where it has gone If you have a baby but no proforma, check proforma in NHSP office and once located move to SCBU inpatient folder. If, after checking all folders, you are unable to locate a proforma print one. Check when baby is 48 hours and highlight on monitoring sheet so that we know we are screening using the NICU baby Protocol For NICU protocol babies, place a copy of the Risk Factor Sheet in the patient notes for each baby for the Paediatrician to complete Give a copy of the Newborn Hearing Screening Information for SCBU parents leaflet to parents or leave the copy with the baby s red book if parents aren t available Ask staff for any updates on babies particularly babies that are likely to transfer to another hospital, are well enough to screen or be discharged home in the next few days Record any necessary updates on the monitoring sheet Feedback to the hearing screeners who are on duty that day, how many babies are on SCBU and need screening Make a decision about who will be doing the screening in the afternoon (taking in to account pressures from clinic and ward work) Always feedback the screening results for SCBU babies to a member of the BUSCOT staff as well as parents When baby has been on SCBU for more than 48 hours change protocol on S4H to NICU be sure to add a case note with admission date and time If a baby has moved out of area add a case note to S4H giving information of where baby has gone and give details of date and time Add any relevant updates to S4H particularly if baby is out of area as responsible site will share in to record and will be checking for updates This document is valid only on date last printed Page 15 of 16

16 8.3 Movement to another hospital If baby moves to another hospital - inform the Local Manger who is responsible for that site (use NHSP Sites contact list) via an appropriate case note on S4H. You will need to give them the date/ time of transfer. Once baby has transferred to another site and you have informed the Local Manager responsible they will share in to the record and add regular updates. They will become responsible for screening that baby or notifying you if baby comes back to RBH or is discharged home without screening. 8.4 Out of area Babies (in SCBU out of area file) Check babies in this folder weekly Login to S4H and check case notes from other sites Check baby is still alive and well and not marked as deceased If no case note call or Local Manager where baby is located and ask for an update and check baby is still there 8.5 Discharged home without screening If it s our baby arrange a clinic appointment If it is out of area and has been discharged from RBH but not screened, inform the Local Manger of responsible site that baby has gone home without having had screening done and ask them to appoint via a case note on S4H. 8.6 Filing of proforma and PCHR Forms Yellow copies of the PCHR forms should be kept with Proforma (stapled together) Risk factor sheets for NICU babies should be filed in the patient s hospital notes File all results in the SCBU completed proforma file (or referral folder or 8 month follow up folder as appropriate) Once file full transfer to an envelope with month and year details of proforma enclosed and place in the appropriate Box in the Local Managers office Any targeted follow-ups need to be placed in the appropriate tray/folder This document is valid only on date last printed Page 16 of 16