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G10 Sample optimisation of newborn blood spot screening; a quality improvement initiative
  1. G Ramadan1,
  2. S Grimes1,
  3. L McSorley1,
  4. K Fegan2,
  5. F Brokke1
  1. 1Neonatal Programme, Medway Hospital NHS FT, Gillingham,UK
  2. 2Women’s Health Programme, Medway Hospital NHS FT, Gillingham, UK


Aims The publication of Public Health England’s (PHE) standards for newborn blood spot screening (NBBS) in 2013 and 2016; mandated a review of practice and sequential change management programme. The aim of the project was to reduce rates of avoidable NBBS repeats in the medway health economy through improvement of blood sample quality. Repeat samples can cause parental anxiety, distress to babies, delays in the screening process and NHS wasted resources.

Methods We defined good quality blood spot sample as one that is taken at the right time; has all data fields completed on the card; contains sufficient blood to perform all tests; has not been contaminated (expired card or anti-coagulated sample); and arrives in the laboratory in a timely manner. We implemented the IHI® model for improvement and instigated transformation through process mapping and a series of Plan Do Study Act (PDSA) cycles. Step changes included a number of technical and non-technical interventions for sample optimisation. These interventions were tracked quarterly through Statistical Process Control charts and were fed-back real-time to frontline teams. Technical interventions were the introduction of automated arch shaped incision devices, emphasise transfusion date/time on cards and enhanced recording of collected/dispatched samples. Nontechnical interventions were pre-dispatch sample peer checks, guideline review and annual competency assessment via interactive e-learning card.

Results We noticed a reduction of 25% in the rate of avoidable repeats within one year after implementation of change [from 2.35% avoidable repeat rate in 2015 to 1.76% in 2016]. This result was better than the national acceptable avoidable repeat rate of 2%.

Conclusion Improvement of newborn blood spot screening sampling quality has been achieved through a series of interventions in the medway area in Kent. This led to a 25% reduction in rates of avoidable repeats and better utilisation of healthcare resources. These results were considered the best among Kent’s NBBS programmes and could be replicated in other areas in the country using the same approach.

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