Guidance

Newborn hearing screening checks and audits

Published 4 July 2018

1. NHS Newborn Hearing Screening Programme

The NHS Newborn Hearing Screening Programme (NHSP) Programme aims to identify moderate, severe and profound deafness and hearing impairment in newborn babies.

Early identification of hearing impairment gives children a better chance of developing speech and language skills, and to make the most of social and emotional interaction from an early age. The programme offers all parents in England the opportunity to have their baby’s hearing tested shortly after birth.

2. Screening pathways

NHS screening programmes have defined pathways. They show how individuals undergoing screening moves from one stage of the pathway to the next. Checks are needed at each stage to ensure the individual moves seamlessly and safely through the pathway, unless they choose not to.

If checks are not in place, there is a risk that an individual will not complete the pathway, or the pathway will be delayed unnecessarily. Quality assurance of screening programmes includes checking that failsafe procedures are in place and operating effectively.

3. Failsafe in screening programmes

Failsafe processes need to be in place in screening programmes. If something goes wrong, these processes help make sure it can be easily identified at the time and action can be taken to correct it before any harm occurs. To support the concept of failsafe being understood, an example is provided below.

3.1 Example of a screening failsafe process

Baby Russell was discharged home within 2 hours of birth, to the care of the community midwives from a neighbouring maternity hospital. The midwife completing the birth registration process inadvertently marked baby Russell as a stillbirth. Information about the baby did not appear in the national NHSP IT system SMaRT4Hearing (S4H), which receives information on live born babies. The NHSP service in the birth unit did not check the local birth registers and did not realise that Baby Russell had been born and then discharged home. As a result, the neighbouring NHSP site that was responsible for the baby was not aware of the need to screen the baby. The baby’s hearing screening status was not checked by the midwifery team or health visitor. At 10 weeks of age, the parents raised concerns with their GP about their baby’s hearing. The baby was referred to audiology and a diagnosis of permanent childhood hearing impairment was made.

As an individual practitioner, please consider if you have a systematic process in place to check that:

• a NHS number is generated for all new births
• S4H has records for all births recorded in local birth registers; then the chance of a baby missing screening is minimised

There is evidence from screening safety incidents reported that some providers are not checking the status of babies along the screening pathway. Or, they have unclear processes for communicating the need for hearing screening when babies transfer from one care provider to another.

Failsafe processes must be timely. They help to identify what is going wrong in real time (as it is happening).

4. Methodology

For each pathway we:

• mapped all the screening safety incidents, including serious incidents reported
• applied findings from peer review quality assurance (QA) visits
• used queries received at PHE screening helpdesk
• listened to a range of stakeholders’ views about risks

This process enabled us to focus on where there are known weaknesses in the pathway.

5. How to use the template

The template outlines:

• what: this is what we recommend that 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

As you work through the document you may wish to check if:

• you already have local processes in place to regularly undertake these checks
• there are any gaps
• you are carrying out these checks often enough

If the answer is no to any of the above, you can use the last column (Trust response) to develop an action plan.

The completed checks and audits document, any action plan developed and the results of any audits, can be used to benchmark services. They can also be used as evidence for QA activities, including peer review visits.

6. Additional audits

We have also included some additional checks and audits that providers could undertake. These audits will help to determine if the whole system is working effectively.

7. Other important resources

This document should be used in conjunction with:

• service specifications
• standards
• screening pathways
• operational guidance

8. Vignettes

We provide the following vignettes to demonstrate what can go wrong when failsafe checks are not in place or when checks are not robust or timely.

8.1 Deceased babies

A baby was stillborn but registered as a live birth. The baby’s parents were contacted and offered NHSP screening, causing them distress.

A NHSP site was not informed following a baby’s death in an out-of-area neonatal unit and contacted the parents to offer screening.

A baby is referred to audiology, but dies before the appointment. Audiology were not informed and contacted the parents.

8.2 Failure to follow NHSP protocols

A baby was screened in hospital and referred to audiology with ‘bilateral no clear response’. Routine data reports highlighted that the baby had not attended the audiology appointment and the newborn hearing screening record was deactivated, with a reason of ‘clear responses’ at screening. Further investigation revealed that the screening result was not recorded in the personal child health record (PCHR) and the baby’s screen was incorrectly repeated by health visitor during a home visit where ‘bilateral clear responses’ were obtained.

A baby with meningitis had a diagnostic referral made. This was unnoticed by the screener and routine newborn hearing screening was undertaken.

Baby had newborn hearing screen (well baby protocol) with ‘clear responses’ but was later admitted to neonatal intensive care units for 3 days. Repeat screen, in line with neonatal intensive care unit (NICU) protocol, was not completed.

8.3 QA checks on screening equipment

A screener fails to perform the QA checks on equipment which is then used to screen babies. There is no systematic process to make sure that QA checks are completed. Routine calibration of the equipment shows there is a fault which would have been picked up by a QA check. Babies screened with the equipment need to be recalled.