Interactive Training Webinar for Newborn Screening …2015 = 1.6% New Data PACE Credit continuing...
Transcript of Interactive Training Webinar for Newborn Screening …2015 = 1.6% New Data PACE Credit continuing...
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
Interactive Training Webinar for Newborn Screening
Specimen Collection
Patrice Held, PhDCo-Director, Wisconsin Newborn Screening and Biochemical Genetics Laboratory
Assistant Professor, Dept of Pediatrics, University of Wisconsin-Madison
August 2014 Survey was sent to all NBS submitters to highlight concerns with specimen collection process
September 2014 Workgroup of DHS, NBS laboratory, Hospital representatives (5) met to review survey responses and
identify/prioritize issues related to specimen collection
October 2014 The same workgroup of DHS, NBS laboratory, and Hospital representatives (5) met to
brainstorm/identify/prioritize way to improve specimen collection
Frequent issues identified by submitters Lack of a consistent site-specific process Lack of instructional materials Lack of training No visual inspection before shipping specimens Using capillary tubes Blood Clotting within circles on the specimen card
QI Project:Reducing unsatisfactory specimen submission
2.77%
2.19%2.32%
2.13%
1.79%
1.62% 1.62%
1.94%1.80%
2.04%
2.53%
1.89%
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Perc
enta
ge o
f Uns
atis
fact
ory
Spec
imen
s
Unsatisfactory Specimen Collection
2014Average:
2013 = 2.6%2014 = 2.0%
Reasons for Unsatisfactory Specimens2014
BLOOD CLOTS 38.4%
INCOMPLETE SATURATION (HIGH
HEMATOCRIT)16.6%
FILTER PAPER DAMAGED
(CAPILLARY)13.0%
INCOMPLETE SATURATION
11.8%
LAYERED SPECIMEN6.7%
SMEARED OR DISCOLORED BLOOD
3.4%
BLOOD ON TAN COVER
3.2%
PLASMA SEPARATED FROM RBCs
2.8%RECEIVED >7 DAYS AFTER COLLECTION
0.8%
Action Items
We were awarded federal funding through the Centers for Disease Control and Prevention to
design a web-based training module for specimen collection
This project was 100% funded with federal funds from a federal program of $16,500. This project was supported by Cooperative Agreement #U60HM000803 funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not
necessarily represent the official views of CDC or the Department of Health and Human Services.National Center for Immunization and Respiratory Diseases (IP)
Office of Surveillance, Epidemiology and Laboratory Services (OSELS)National Center for HIV, Viral Hepatitis, STDs and TB Prevention (PS)National Center for Zoonotic, Vector-borne, and Enteric Diseases (CK)
National Center for Environmental Health (NCEH)Coordinating Office for Terrorism Preparedness and Emergency Response (CTPER)
Wisconsin Newborn Screening Program
Basics on newborn screening specimen collection and submission
Helping babies get started on the right foot
www.slh.wisc.edu/moodle
Released in April 2015
Learning Objectives
Illustrate proper blood specimen collection
Outline the precise steps to take after blood collection
In the event of an unsatisfactory specimen, explain the necessary steps for specimen recollection
Describe quality assurance activities a submitter must utilize to ensure the collection process is performed correctly and consistently on all babies
Webinar Format
The training covered in this webinar is specific to the process for blood collection and submission
This webinar is approximately 60 minutes long and includes:Pre- and Post-tests
Family StoryTraining module
Webinar EvaluationAvailable for PACE credit
Demographic Information
N=676, 9 months after release
180
321
5
132
0
38
0
50
100
150
200
250
300
350
Phlebotomist Nurse Midwife Laboratorian Physician Other
Which of the following best describes your job/title?
Demographic Information
N=676, 9 months after release
465
117
31 32
105
38
0
50
100
150
200
250
300
350
400
450
500
Collect Specimenand Complete Card
Information
Only CollectionSpecimen
Only CompleteCard Information
Supervisor Package Specimens Other
What is your role in the NBS specimen collection process?
Overall Quiz Results
Mean=6.2 Mean=8.2
P value <0.0001
The whiskers represent the min and max value scored by any one learner. The box represents the 25th and 75th
percentile.
Pre-Te
st
Post-T
est
0
5
10
15S
core
s(1
0 po
ssib
le p
oint
s)
N=676, 9 months after release
2.5%
2.2%
2.0%
2.1%
1.4%
1.0%
1.2%
1.4%
1.3%1.3% 1.4% 1.4%
2.8%
2.2%2.3%
2.1%
1.8%
1.6% 1.6%
1.9%1.8%
2.0%
2.5%
1.9%
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Un
sats
fact
ory
Sp
ecim
en R
ate
2015
2014
Unsatisfactory Specimen Collection
April 20, 2015 distribution of webinarAugust 15, 2015 distribution of postersAverage:
2013 = 2.6%2014 = 2.0%2015 = 1.6%
PACE Creditcontinuing education
During the 9 month period from release of the webinar, 409 out of 676 total learners (60.5%) obtained PACE credit after viewing the webinar.
Evaluationrelevance of material
396 total respondents to survey
EvaluationDelivery of Content
396 total respondents to survey
EvaluationDo you intend to use this webinar for training?
8 (8%)
11 (10%)
82 (81%)
No
NA
Yes
“This is the second facility I have worked in within the state of Wisconsin in 22 years. This is the first time I have actually been trained. Most information I learned by fellow workers training me but some information I was taught was incorrect. Thank you.”
• 58% are already using webinar for staff training• 8% indicated that they will use it for yearly
competency assessments
“This link has been forwarded to all laboratorystaff involved with the collection process andwill be the subject of discussion at the nextlaboratory staff meeting.”
YES
NO
NA
EvaluationDo you have any suggestions for future versions of this webinar?
46 (46%)
9 (8%)
46 (46%)
No
NA
Yes
52% pace was too slow 21% would prefer video (not slides) of collection14% would like to see other webinars
• Specimen collection in premature infants• Hearing Screening• Heart Screening
7% requested more personal stories
Yes No
NA
Next Steps Consider creation of additional training
webinars Webinar on collection requirements for pre-
mature, low birth weight, sick newborns• Release on March 1, 2016
Webinar on hearing screening Webinar on heart screening
Develop learning management system to house training webinars
• Release on March 1st, 2016
www.slh.wisc.edu/moodle
Things I have come to learn…
There’s no such thing as perfect or complete…only continuous improvement.
Acknowledgements
Lisa Burley, Burley Consulting Brain Ploeckelman, DoIT, UW-Madison
Jan Klawitter, WSLH Dr. Mei Baker, WSLH
Dr. Charles Brokopp, WSLH
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
Helping babies get started on the right foot
Nov 2013
Jan 2014
Mar 2014
Jul 2014
Sep 2014
Mar 2015
Apr 2015
Timeline of Wisconsin’s Quality Improvement Projects
Aug 2014
• Specimens missing key information
• Unsatisfactory Specimens
• Timing of Specimen Collection
• Timing between specimen collection and receipt at the laboratory
Wisconsin Quality Assurance:Monthly Submitter Report
Transit Time: Collection to Receipt
2014
Average:2013 (<=3d) = 87.1%2013 (<=4d) =96.9%
2014 (<=3d) =97.0%2014 (<=4d) =99.5%
94.1%
97.3%97.6%
97.3%
96.4%
98.2%
97.3%97.7%
95.8%
97.8%
97.4%
96.7%
99.0%99.3%
99.8%99.6%
99.4%99.8%
99.5% 99.6% 99.4%99.8% 99.6% 99.5%
91.0%
92.0%
93.0%
94.0%
95.0%
96.0%
97.0%
98.0%
99.0%
100.0%
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
% o
f Spe
cim
ens
Rec
eive
d
<=3d
<=4d
Specimen Collection (24-48 hours)
84.5%
85.5%
84.1%
88.7%
89.2% 89.3% 89.6% 89.8%90.8%
92.1% 91.6%
92.5%
89.9% 90.1%
91.3%
92.8%92.2%
93.0%
78.0%
80.0%
82.0%
84.0%
86.0%
88.0%
90.0%
92.0%
94.0%
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
% In
itial
Spe
cim
ens
Col
lect
ed 2
4-48
h
24-48h
plus <24h w/ repeat
2014Average:2013 (24-48h) = 83.2%2014 (24-48h) = 89.0%
Newborn Screening Program in Wisconsin
Screening for Hearing
loss
Screening for Critical
Congenital Heart Disease
Screening for 44 different
conditions through a dried
blood spot
Importance of Timing: The Thompson Family
Testing Baseline Knowledge
Quiz Question #1
Order the following list of events within the specimen collection process.
a. Elevated the baby’s heart above the legs and warm the foot with a heating device
b. Clean the selected puncture site with an alcohol wipe
c. Puncture the skind. Wipe away the first drop of bloode. Gently allow droplet of blood to saturate the filter
paper specimen
Quiz Question #2
Indicate the ideal location for puncture site on the baby’s foot:
Quiz Question #3
How large of an incision should the lancet make in on the heel of a full term infant?
a. 1.0 mm deep by 2.5 mm longb. 0.85 mm deep by 1.75 mm longc. 1.5 mm deep by 2.0 mm longd. 2.5 mm deep by 2.5 mm longe. None of the above
Which of the following pieces of information is NOT critical for reporting of the newborn screening results:
a. Birth weightb. Birth date and timec. Collection date and timed. NICU statuse. Mother’s namef. Physicians name and contact informationg. Gestational age
Quiz Question #4
Quiz Question #5
Which of the pictures below represent the most common reason for unsatisfactory specimens?
6.8%7.0%
5.4%
4.9% 4.9%4.6%
4.9%
4.1% 4.1%
4.7%
4.2%4.4%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
% S
peci
men
s R
ecei
ved
Mis
sing
Key
Info
Missing Key Information*
2014Average:2014 = 5.0%
*birth weight, birth date and time, collection date and time, gestational age
6.8%7.0%
5.4%
4.9% 4.9%4.6%
4.9%
4.1% 4.1%
4.7%
4.2%4.4%
5.3% 5.4%5.2%
4.5%4.2% 4.0%
4.2% 4.3%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
% S
peci
men
s R
ecei
ved
Mis
sing
Key
Info
2014
2015
Missing Key Information*
*birth weight, birth date and time, collection date and time, gestational age
Average:2014 = 5.0%2015 = 4.6%
Specimen Collection (24-48 hours)
2015
93.9%
94.6%
94.9%94.6%
95.7%
95.3%
96.2%
95.8%
94.4%
95.2%
95.5%95.2%
96.2%
95.8%
96.7%
96.4%
92.0%
92.5%
93.0%
93.5%
94.0%
94.5%
95.0%
95.5%
96.0%
96.5%
97.0%
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
% In
itial
Spe
cim
ens
Col
lect
ed 2
4-48
h
24-48h
plus <24h in compliance
Average:2013 (24-48h) = 83.2%2014 (24-48h) = 89.0%2105 (24-48h) = 95.1%
Transit Time: Collection to ReceiptWithin 3 days
96.4%
97.7% 97.7%98.6%
96.5%
98.6%
97.0%97.8%
94.1%
97.3% 97.6% 97.3%96.4%
98.2%97.3% 97.7%
95.8%
97.8%97.4%
96.7%
80.0%
82.0%
84.0%
86.0%
88.0%
90.0%
92.0%
94.0%
96.0%
98.0%
100.0%
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
% o
f Spe
cim
ens
Rec
eive
d
<=3d (2015)
<=3d (2014)
Average:2013 2014 2015
<=3d 87.1% 97.0% 97.5%<=4d 96.9% 99.5% 99.6%