VIRGINIA CHILD ID PROGRAM AND

IMPLEMENTATION AT INOVA HEALTH SYSTEM

Starting July 1st…

• Virginia law will require hospitals that provide maternity services to offer to obtain a blood sample for child identification purposes. This sample is to be given to the parent/guardian of each infant born at the hospital.

• § 32.1-134.02. (Effective July 1, 2012)• Every hospital providing maternity care shall offer to obtain a sample of

blood from an infant born at the hospital and provide that sample to the mother of the infant.

• (2011, c. 621.)

General Information

• This blood sample can be used by the parents if they need to obtain DNA analysis to help identify a child in the event of an emergency such as an accident, natural or manmade disaster, or abduction.

• The hospital is not responsible for storage or testing of the baby’s DNA. As health care providers, we must offer to obtain a blood sample. The parent/guardian may decline. After collection, the storage of the sample is the responsibility of the parents.

• Certain interventions done in the NICU may preclude the blood spot from being done prior to discharge.

How the Order Will Appear At Fairfax

• On the written orders, there will be a stamp that says, "Blood Spot, Virginia ID Program.“

• The order will appear in GECE under Lab A-Z under VA Child ID Program.

For CPOE Hospitals, Orders for FCC Babies As Below

For CPOE Hospitals, Orders for NICU Babies As Below

At Inova Loudoun Hospital

• On the Standing Orders, there will be an order for “Blood Spot, Virginia ID Program”.

• The test will be documented in the nursing notes.

• The consent/ receipt form will be scanned as part of the medical record.

Procedure• Parents will be provided a handout, Child Identification

Program Information for Parents, on admission to L&D.• Upon transfer to FCC or NICU, an order will be entered for blood

collection.• Parent/guardian for infant can agree or decline the blood spot

collection. Parent/guardian will indicate their decision on the consent form. For hospitals using CPOE, if parent/guardian does not want a sample collected; cancel order in computer.

• On FCC, the blood spot for the Child ID Program will be collected in the presence of the parent/guardian. It is recommended that the blood spot be collected at the time of another blood draw, such as the Metabolic Screen collection.

• In NICU, the blood spot for the Child ID Program can be drawn with the metabolic screen or at another mutually agreed upon time with the parent/guardian. The NICU RN is responsible for blood spot collection in the NICU.

Copy of Parent Agreement

Procedure Continued

1. Verify consent with the parent/guardian.2. Put on gloves to avoid contaminating the Child ID card.3. Appropriately identify the newborn.4. Use patient labels to document the newborn’s name and date of

birth on the stain card and on the outside of the foil pouch .5. The sample will be collected in the presence of the

parent/guardian.6. The collector will fill in the circle on the card using concentric

circular motion. This is similar to how a metabolic screen is collected, don’t puddle, rub, or smear the sample.

After Collection• You will collect the specimen using as usual. That will transmit the

“collected” message to Lab and then the Lab will “receive” it. Next, send a small patient label to the Lab to verify collection and then the Lab can acknowledge it.

• The Child ID card will need to dry for at least 30 minutes, ideally for 4 hours.

• This can be done by placing it on the bedside table and setting it up in a triangular position.

• If left in patient’s room, advise family members to avoid touching the card.

Sealing the Envelope1. After blood spot is completely dry, the RN will put the card,

along with the desiccant into the foil pouch and seal. The desiccant aids in preserving and drying the sample.

2. The RN will give the sealed envelope with the DNA spot to the parent/guardian. The parent/guardian will sign the form acknowledging receipt of the card and responsibility for storage of the card.

3. Patient instructions: Instruct the parent/guardian, once the stain card is sealed in the foil pouch, it is protected from contamination as long as the pouch remains sealed. The pouch should not be opened until DNA analysis is to be performed.

How Will Results Appear on the Computer?

Supplies• Inova will be using the FITZCO Child Identification Kit.• Each kit contains: instructions, DNA collection paper, desiccant,

and storage pouch.

Additional Hospital Specific Instructions

• Inova Alexandria:– On postpartum, the specimen will be collected in the presence of the

mother and the card will be left to dry on the mother’s bedside table and then given to her.

– For NICU infants, the blood spot will be collected by the RN in the mother’s presence at a time mutually agreed upon by the mother and nurse collecting the specimen. The card will be left to dry on the bedside counter and then given to the mother or next of kin.

• Inova Fair Oaks: – Physician will enter the order into CPOE. – The specimen will be collected in the presence of the mother. On FCC

it will be collected by phlebotomy. For NICU infants, the blood spot will be collected by the RN in the mother’s presence at a time mutually agreed upon by the mother and nurse collecting the specimen.

– The card will be left to dry on the mother’s bedside table on FCC or on the supply cart in the infant’s room.

Additional Hospital Specific Instructions

• Inova Loudoun: – The specimen will be collected by the RN in the nursery with the

mother present to verify the identification of the infant and the labeling of the specimen. After collection, when the sample is dry and sealed, the RN will give card to the mother and obtain her signature.

• Inova Fairfax: – The phlebotomist will collect the specimen and place in box in the

patient’s room.– Phlebotomist will notify RN after collection completed. RN will seal

specimen after 30 minutes and provide to the mother.– In the NICU, the blood spot will be drawn at discharge in the

presence of the mother. If the infant receives a blood transfusion, the blood spot must be deferred for 10 days. In the case that the infant is discharged in this time period, the parent/guardian will receive instructions on how to obtain the test after discharge.

Possible Scenarios1. You are a FCC Nurse and are preparing a baby for discharge. You realize that the DNA spot was not offered nor drawn with the Metabolic Screen. The mother is in ICU in critical condition. What do you do?

-Suggested action: Determine if there is a designated decision maker. Provide the information on the Virginia Child ID Program and offer to collect a blood sample. 2. You are a NICU nurse, your patient is within a week of discharge and the mother wants the blood spot done. She does not want the baby to get any additional sticks. What can you tell her?

-Suggested action: Inform mother when the baby has upcoming scheduled lab tests. Tell her that if she is available at the same time, we can obtain the blood spot at that time, without

additional sticks.

Key Points1. On July 1st, according to Virginia law, we have to offer

to obtain a blood sample from each newborn born at our hospital for the purposes of child identification.

2. Parent/guardian can decline, but this needs to be documented to show compliance with the law.

3. Every effort will be made to collect the specimen in the presence of the parent/guardian.

4. We will collect the sample, but we will not conduct any testing on the sample. After the envelope is sealed, storage is the responsibility of the mother.

5. Gloves must be worn at ALL times when handling the card to avoid contamination with the collectors DNA.