Making the Grade: A Sustainment of Florida Newborn Assessment Screen Metrics
Newborn lab screening is essential for recognition of conditions that impact neonatal morbidity and mortality. A quaternary, urban hospital received a failing state issued rejection grade for eight subsequent quarters. A nursing-led multidisciplinary taskforce influenced the scores by deep diving data, comparing populations, and producing literature backed interventions specific to the hospitalized newborn population. After three years, four PDSA cycles, and the collaboration of over 300 nurses, the hospital now proudly displays an A grade- highlighting value of continual improvement in successful sustainment.
Problem: A large children's hospital failed state inspections for eight quarters. Sample rejections could delay diagnosing and treating metabolic disorders, leading to increased neonatal morbidity and mortality due to the need for sample retesting.
Measurement: Initially a nursing-led multidisciplinary taskforce impacted the scores by deep diving data. A cross reference of rejected samples between the campus laboratory and the State of Florida laboratory produced data for the taskforce to analyze including infant name, collection unit and nurse, rejection type, date of collection, and physician.
Analysis: Leadership's prior focus on nurse education failed. In this project, the taskforce used stratified data to identify rejection differences by population/unit and apply literature-based interventions. Data analysis spanned four cycles, each with it's own focus (rejection, sustainment, environment, and supply).
Implementation: Within the healthy newborn population, a point-of-care tool was developed to assist bedside nurses with simple identification of a quantity not sufficient sample (Moat, 2020). In the increased acuity intensive care newborn population, education was provided on indicators for hyper saturation (Clinical Laboratory and Standards Institute 2019).
Results/Discussion: The taskforce improved the metric from an 'F' to a 'B' in four quarters using PDSA cycles. Three more cycles addressed rebounding high rejection rates, sustaining a 'B' and achieving an 'A' over twelve quarters.
Speakers
Lead Lactation - AdventHealth for Women
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Health Data Analytics
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Location Virtual
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Organizer NAHQ Next
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