Newborn Hearing Screening Protocol (CG570)

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 6 th April 2018 Change History Version Date Author, job title Reason 1.0 March Jo Young, Team Lead Trust requirement 2016 2.0 March 2018 Ali McMasters, Newborn Hearing screening manager Review due This document is valid only on date last printed Page 1 of 14

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) This document is valid only on date last printed Page 2 of 14

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-andyour-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 This document is valid only on date last printed Page 3 of 14

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 1 st 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 2 nd 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 This document is valid only on date last printed Page 4 of 14

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). This document is valid only on date last printed Page 5 of 14

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 followup 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. This document is valid only on date last printed Page 6 of 14

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. This document is valid only on date last printed Page 7 of 14

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. This document is valid only on date last printed Page 8 of 14

Aspect of compliance or effectiveness being monitored Monitoring method Individual or dept. responsible for the monitoring Frequency of the monitorin g 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 S4H LM daily LM LM/TL Out Discrepant Data Reports S4H National Team/Local monthly LM LM/TL Audiology Appointment Search Missing results search Yield Report Manager S4H LM Weekly LM LM/TL S4H LM Weekly LM LM/TL 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 Individual screener report Annual Report National Team S4H National Screening Committee National Team/Local Manager Local Manager NHS Public Health England, Trust Board and Head of Midwifery and LANNBSG LM/TL and chair of the LANNBSG and Head of Midwifery monthly LM LM/TL 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. This document is valid only on date last printed Page 9 of 14

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 Jo Young Team Leader rbft.screening@nhs.net Jo.Young@royalberkshire.nhs.uk Audiology 0118 322 7238 Child Health Information Services 0207 004 1501 This document is valid only on date last printed Page 10 of 14

Appendix 1 - Well baby Protocol https://www.gov.uk/government/publications/newborn-hearing-screening-carepathways This document is valid only on date last printed Page 11 of 14

Appendix 2 - Newborn hearing screening NICU or NNU Protocol https://www.gov.uk/government/publications/newborn-hearing-screening-carepathways This document is valid only on date last printed Page 12 of 14

Appendix 3 Decline of screening- well baby This document is valid only on date last printed Page 13 of 14

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