Newborn and Infant Physical Examination (NIPE) Screening programme: checks and audits to improve quality and reduce What This is what we recommend you do Why These are the reasons why we are recommending this How This is how you might do this When This is how often we recommend you undertake the action/check Additional checks and audits 1. Identify the eligible population (new births): Have systems in place to identify the new birth population that you have responsibility for, including babies on the neonatal unit and paediatric wards Maternity units must generate a NHS number for all new births. This must be done accurately and timely prior to screening, to ensure population of the national NIPE IT system, NIPE Screening Management and Reporting Tool (SMART) To ensure that the eligible population is identified and all babies born with congenital abnormalities of the eyes, heart, hips, and testes, are examined and referred within 72 hours of birth. To identify abnormalities that may become detectable by 6-8 weeks of age, at the second physical examination (thereby reducing morbidity and mortality) We have evidence from key performance indicators (KPIs) and screening safety incidents of incomplete or delayed NIPE screening for some babies because: Have a mechanism in place to cross check birth notifications, ward lists and home births to identify eligible cohort. Local process for sharing information of babies between neonatal and paediatric wards and the maternity service responsible for NIPE screening On every day the service operates Use the national monthly data reports to check that eligible babies are identified, as detailed in the NIPE SMART user guide (Available on NIPE SMART) NIPE performance data is submitted on KPI NP1 (NIPE coverage by 72 hours) quarterly. Review the list of babies who have breached the KPIs and investigate the
Local service to search national NIPE IT system to ensure that all babies have entered into the screening pathway they are not offered screening at the time, or, are not offered screening at all of unnecessary delays between screen positive and referral and assessment (for hip ultrasound in particular) they late into the screening pathway they are on neonatal and other paediatric wards Ensure checks are in place to comply with data exception reports found in the NIPE user guide and handbook () reason why, and arrange screening as required. Submit data on KPIs NP1 (standard 1: newborn coverage to the NHS screening programmes) - quarterly Trust response: this row is for you to enter results, or, summarise whether you have these checks in place. If not, you can use this space to identify gaps and develop an action plan. What This is what we recommend you do Why These are the reasons whywe are recommending this How This is how you might do this When This is how often we recommend you undertake the action/check In addition to failsafe 1. Identify the eligible babies (movers in): Have systems in place to identify the movers in, transferred in population, and those born at home and babies on neonatal and paediatric wards, that you have responsibility for Have mechanism in place for NIPE services to be informed, To make sure the eligible population is offered screening in the correct timeframe. Earlier diagnosis leads to improved screening outcomes. Newborn screening should be completed and recorded as soon as possible. Babies are eligible for newborn screening until 6 weeks of age We have evidence from KPIs and screening safety incidents that Child Health Information Services (CHIS) interrogate their information system, searching for any babies aged 6 weeks without a valid screening result, or, a recorded decline, and inform the local NIPE service provider On every day the service operates Use the national monthly data reports to check that eligible babies are identified as detailed in the NIPE User Guide (Available on NIPE SMART )
and screening offered and completed, for any unscreened baby less than 6 weeks of age moving into the area. NIPE local service to search NIPE SMART to ensure all babies have entered into the screening pathway screening is incomplete or delayed because: babies are not offered screening of unnecessary delays in completing the newborn examination babies are not clearly identified as requiring NIPE on transfer home, or, to another unit babies are not transferred on NIPE SMART in a timely fashion babies born at home are not always clearly identified as requiring NIPE checks are in place but are not timely Health visitors (HV) to check that screening is performed and inform NIPE service provider if there is no evidence of screening Maternity users of NIPE SMART should manage ‘movers in’ and ‘transfers out’ on NIPE SMART, and use a documented handover process (to the receiving providers) wherever possible Trust response: this row is for you to enter results, or, summarise whether you have these checks in place. If not, you can use this space to identify gaps and develop an action plan. What This is what we recommend you do Why These are the reasons why we are recommending this How This is how you might do this When This is how often we recommend you undertake the action/check In addition to failsafe 3: Identify the eligible babies who are ‘too ill for screening’: Have systems in place to identify those ‘too ill for To ensure eligible population is tracked and offered screening in the correct timeframe. Earlier diagnosis leads to improved screening outcomes. Child Health Information Services (CHIS) interrogate their information system, searching for any babies On every day the service operates Use daily worklists and the national monthly data reports to check that eligible babies are identified,
screening’ that you have responsibility for (in line with national guidance and make sure that they are offered screening when well enough) Have mechanism in place for NIPE services to be informed of any baby less than 6 weeks of age who is too ill for newborn screening NIPE local service to use NIPE reports and local searches, to ensure all babies are tracked and have entered into the screening pathway Screening should be completed as soon as possible, and a result recorded. Babies are eligible for newborn screening until 6 weeks of age We have evidence from KPIs and screening safety incidents of: babies who are not offered screening screening for all 4 screening elements not completed screening referral pathways not being completed unnecessary delays in completing the newborn examination aged 6 weeks without a valid screening result, or, recorded decline, and inform the local NIPE service provider HVs to check that screening has been performed (as per service specification), and inform NIPE service provider if there is no evidence of screening Maternity users of NIPE SMART should manage ‘movers in’ and ‘transfers out’, and use a documented handover process (to the receiving providers) wherever possible as detailed in the NIPE user guide, (available on NIPE SMART (SMART) Trust response: this row is for you to enter results, or, summarise whether you have these checks in place. If not, you can use this space to identify gaps and develop an action plan. What This is what we recommend you do Why These are the reasons why we are recommending this How This is how you do this When This is how often we recommend you undertake the action/check Additional checks and audits 4: All deceased babies are identified To ensure that a deceased baby’s records are updated on NIPE NIPE local service to be informed of any deceased Contacts list is updated following each baby’s death Stakeholders complete 6 monthly check to confirm that
Have systems in place to identify any deceased baby and to inform other relevant screening and clinical services without delay SMART and child health information system We have evidence from screening safety incidents of: families of deceased babies contacted to be offered screening babies via maternity, paediatric, or, Child Health Information Services, and take appropriate action in line with NIPE local service should be included in the routine list of contacts informed of a baby’s death A contact list is maintained and regularly updated by all pathway providers all deceased babies were identified and communicated in a timely manner Trust response: this row is for you to enter results, or, summarise whether you have these checks in place. If not, you can use this space to identify gaps and develop an action plan. What This is what we recommend you do Why are the reasons why we are recommending this How This is how you might do this When This is how often we recommend you undertake the action/check Additional checks and audits 5. Provide information and offer the screening test: Have systems in place; for the screener to check that parent/carer has received a copy of Parents are aware of screening test available for their baby and the national standard timescales, therefore, prompting requests for screening if it is not offered/performed Check that ‘Screening tests for you and your baby’ has been given Acceptance of screening recorded ‘Screening tests for you and your baby’ is given at booking and revisited before screening Consent is obtained prior to screening being undertaken Make sure consent/decline is correctly ascertained by screening staff during their annual competency assessment
‘Screening tests for you and your baby’, and this information is discussed prior to screening being offered to check that the screener obtains verbal acceptance of screening as an informed choice from the mother, (or person with parental responsibility), before carrying out screening to ensure that screening pathway is only completed when an informed choice to accept screening has been given There is an expectation that if screening is accepted, the screening pathway is completed. Screening cannot be carried out without parents making an informed choice to accept screening To make sure parents are informed, have choice and that the limitations of screening are understood To make sure parents understand the need to screen, and that if screen positive on assessment, the importance of attending follow up appointments for eyes and hip as per national guidance. Parents informed that screening is not 100% accurate and not diagnostic on the local notes, NIPE SMART, and PCHR. Where an informed choice to accept screening has been given, that screening has been completed and an outcome set accept//decline to make sure screening completed for all babies Audit that the booklet was given; as evidenced by records in the maternity notes/system - annually Trust response: this row is for you to enter results, or, summarise whether you have these checks in place. If not, you can use this space to identify gaps and develop an action plan. What This is what we recommend you do Why These are the reasons why we are recommending this How This is how you might do this When This is how often we recommend you undertake the action/check Additional checks and audits 6. Informed choice to decline NIPE screening To make sure that the limitations of the screen are communicated and understood Declines should be recorded on NIPE SMART. Parents should be given When screening is declined To review and monitor the number of declines as detailed in the quarterly data
Have mechanisms for recording declined screening in to: make sure parents make an informed choice monitor declines know the outcome of the offer of screening Parents should be able to decline the screen information on what to do/who to contact if they change their mind, and what they should do if they are worried in the future about any aspect of their baby’s development The HV and GP should be informed reports and investigate any significant changes Trust response: this row is for you to enter results, or, summarise whether you have these checks in place. If not, you can use this space to identify gaps and develop an action plan. What This is what we recommend you do Why are the reasons why we are recommending this How This is how you might do this When This is how often we recommend you undertake the action/check Additional checks and audits 7. Identify babies where screening is incomplete Have systems in place to track the eligible population from offer to receipt of a valid screening result, or, confirmation of decline. Have process for remedial action to offer and undertake screening Earlier diagnosis leads to improved screening outcomes. We have evidence from screening safety incidents of: eligible babies not offered screening screening not being completed babies screen positive for the 4 conditions not being referred in a timely manner for e.g. for hip ultrasound NIPE local service to check NIPE SMART for babies without a screening outcome, and take appropriate action in line with guidance (service specification and NIPE handbook) Regularly interrogate NIPE SMART and the Child Health On day the service operates Use the daily worklist and local checks to identify the eligible cohort. Use national monthly data reports to check that eligible babies have been identified, (as detailed in the NIPE user guide – available NIPE SMART) and screening arranged as required for babies
Checks should be in to ensure that data is recorded, and a screening outcome known and recorded for each baby lack of follow up - screening outcomes are not obtained for all screen positive referrals inability to confirm completion of the screening pathway for all screen positive babies screening outcomes not always recorded for babies on NICU/PICU on NIPE SMART CHO not always receiving outcome of NIPE examinations as specified by NIPE guidance Make sure maternity communicate with CHO, and that they have a process to make sure NIPE screening results are recorded on CHIS systems searches on NIPE SMART system to follow up babies without screening outcomes of screening outcomes recorded on CHIS - quarterly Trust response: this row is for you to enter results, or, summarise whether you have these checks in place. If not, you can use this space to identify gaps and develop an action plan. What This is what we recommend you do Why These are the reasons why we are recommending this How This is how you might do this When This is how often we recommend you undertake the action/check In addition to failsafe 10. Babies who screen positive or with suspected abnormalities of eyes, heart, hips and testes, are referred and seen in line with national standards and guidance, and screening outcomes followed up: Have systems in place to: Earlier diagnosis leads to improved screening outcomes. We have evidence from screening safety incidents of: delay in hip ultrasound appointment due to administrative delays or capacity lack of follow up Screening team that made the referral requests confirmation that the referral was received. DNAs are followed up according to local policy Audit the referrals and outcomes of referrals on a monthly basis Cross-check by use of monthly and /quarterly reports Use the national monthly data reports to check that babies referred have outcome recorded on NIPE SMART NIPE user guide (Available on NIPE SMART)
provide information to help decision making for parent/s by a trained HCP supported by NHS NIPE programmes resources so they know who to refer to provide information and follow up support to parent/s Reporting function used from NIPE to identify outstanding babies against the predefined search criteria delay in diagnosis due to non-attendance Use of predefined reports within NIPE SMART to identify breaches and performance against NIPE standards Local NIPE lead to carry out administrative functions within the NIPE SMART, to make sure screen positive babies are referred and have attended appointments Post-referral outcomes entered onto NIPE for all target conditions (eyes, heart, hips and testes) Ensure maternity have a process to be notified of screening outcomes for referrals. Update NIPE SMART Maternity and Child Health to run and use predefined search functions to identify outstanding babies NIPE User Guide (Available on NIPE SMART) NIPE service data is submitted on KPI NP2 (referral for DDH ultrasound), to the NHS screening programmes - quarterly Review list of babies who have breached the KPI to investigate reason why, and follow up arranged Audit of referrals to cardiac centre - annually