Getting Down to Zero: DHEC Provides Newborn Screening Training in an Effort to Eliminate Unusable Samples and Save Lives

Thanks to the South Carolina Newborn Screening Collaborative “On Time Every Time” Initiative, our state’s hospitals have made dramatic improvements in getting newborn screenings done in a timely manner. With new procedures in place, neonatal clinics are now drawing blood samples from newborns in that crucial 24- to 48-hour time window after birth and sending them to DHEC’s lab to test for a host of rare diseases that can be debilitating and even life-threatening when not treated promptly. 


This initiative has become so successful that DHEC is now focusing on another area of equal importance—the samples that arrive in the lab are “unsatisfactory” and aren’t adequate enough to test. DHEC has now been offering newborn screening training for healthcare workers involved in collecting specimens to ensure they can reliably get an appropriate sample and are aware of the various possible pitfalls that could lead to failure.


SCHA asked Dana Smith, RN, the Program Coordinator at DHEC, a few more questions about these screenings in an effort to illustrate the importance of these training sessions.


Why are these newborn screening trainings necessary?


Dana Smith: Newborn screening training is necessary to improve the quality of specimens that are sent to the DHEC lab. When an unsatisfactory specimen is received and the DHEC lab recognizes that it can’t be used for testing, a repeat specimen is requested.


There are many factors that influence the collection of a satisfactory repeat specimen. For example, a primary care physician can obtain the repeat in the office or send the guardian to a participating hospital or county health department. This puts unnecessary stress on all parties involved, but especially the infant, when a satisfactory specimen could have been collected correctly the first time at birth.  This issue can delay diagnosis of a potential life-threatening condition.


Our “First Time Every Time” initiative is a follow up to our collaboration with SCHA's On Time Every Time initiative. This initiative began to meet the national standard of having primary care providers aware of urgent abnormal results by five days of life and non-urgent abnormal results by seven days of life. As you can see, if the first specimen isn’t a quality specimen and the infant is in need of a repeat specimen, this goal will be difficult to attain. We have been working with the hospitals since 2014 on the timeliness of their specimens and now with this training, we hope to improve the quality of the specimens collected.   



In concentrations outside of medicine, a 4% margin of error might seem insignificant but we know that's not the case when dealing with babies' lives. What has the Newborn Screening Program done to help hospitals improve and reach the nation average? 


What may seem a small percentage is actually a large one when an infant’s life could be in danger from not being able to identify a life threatening disorder in a timely manner. The national unsatisfactory rate is 2%. Our state’s unsatisfactory rate, as of last month, is 4%. When you look at the 54,000 babies born a year in SC, that would mean on average 2,160 babies had specimens that were not collected appropriately. From a newborn screening standpoint, this is unacceptable. If we miss just one baby, that screening could have prevented an undesirable outcome, that is one too many. Catherine Heigel, the Agency Director for DHEC, has a goal to be one of the premier public health agencies in the nation and one of our agency’s core values is pursuing excellence. In order to do this, we cannot continue to have rates double the national average for unsatisfactory specimens. We are hoping that collaborating with SCHA on our initiatives, hospital reports, and most recently the hospital training will help move the needle on timeliness and unsatisfactory specimens.


Walk me through what goes on at the training—what are the key points?


The key points in the training are:


·         The “Train the Trainer” workbook review, which gives the hospital staff all of the tools to be able to train their staff appropriately.

·         The lab instructor also dives into the First Time Every Time initiative.

·         Participants get important information on how the filter paper device works and the importance of handling the device correctly, as well as learn the importance of legible documentation.

·         Common errors and barriers are discussed with the participants.

·         Parent Education is required by the hospital staff and reviewed accordingly.

·         Puncture site, process and collection is reviewed and demonstrated by all participants.

·         Unsatisfactory and Satisfactory Specimen examples are reviewed in order to educate the participants on what the DHEC lab is looking for.

·         The participants are shown and educated on the correct procedure for mailing and shipping the specimens to the DHEC lab.

·         The Follow up Program coordinator reviews the 53 different disorders that SC screens for and the follow up protocol for repeat specimens.



How have nurses responded to the training?


Evaluations have been received from participants including nurse managers, nurse educators, hospital staff, phlebotomy staff, and med techs. The consensus has been that the training workshops are welcomed. Words of appreciation have been given verbally as well as documented on the evaluation form collected at the end of the training. Many of the participants have stated that they are going to review their current procedures and implement what they have learned in the training provided. Many of them were surprised to discover that their collection methods were contributing to unsatisfactory specimens. 


What’s coming up in soon in regards to newborn screenings?


·         Development of the new data system for the DHEC lab and follow up team

·         CF/ DNA testing (DHEC Lab)

·         Possible statewide courier system (Pilot stage)

·         Yearly Regional Hospital Trainings

·         Yearly individual hospital report cards to assist with QI measures

·         Continuing monthly hospital reports

·         NICU protocol Implementation


For more information about our program, educational handouts, protocol manual and an overview of all the disorders that SC screens for, please go to our website here.



10-10-2016 04:46 (EDT)