Neonate heel pricks for screening

[dawnbee]

I work in a small rural hospital as a Perinatal Nurse. It has always been the hospital policy to call a lab tech in to draw blood for PKU screening before discharge. Several of us would prefer to do the heel pricks ourselves, as it would save time if we could test the babes rather than wait for lab to come around after our moms get a discharge order. Management is all for it, as are the lab people, however, before we can write a policy, we need to do some research about whether it is common practice in other hospitals for RNs to perform this task. My feeling is that if I am qualified to start an IV in a scalp vein, I can probably handle a heel prick, and I can make it easier on the babe by using EMLA and hot packs before even attempting the procedure. Who does screening in your hospital?

[Mimi2RN, ASN, RN]

Originally Posted by USA987

We also do our own after 24 hrs. of age. BUT it is the discharging RN's responsibility to look it up in the computer and ensure that the lab has received if. If you send a baby home without the PKU being done it's a mandatory DAY OFF WITHOUT pay!!

Have they ever done that? I can't imagine paying a fine for something like that!

If lab is coming for an am draw, they will do our PKU's which are ordered to be done before day 6. The RN's and LVN's do the pp ones during the night, before discharge.

We don't use EMLA on the newborns. Sometimes we use sucrose, depends on the nurse.

Originally Posted by dawnbee

I work in a small rural hospital as a Perinatal Nurse. It has always been the hospital policy to call a lab tech in to draw blood for PKU screening before discharge. Several of us would prefer to do the heel pricks ourselves, as it would save time if we could test the babes rather than wait for lab to come around after our moms get a discharge order. Management is all for it, as are the lab people, however, before we can write a policy, we need to do some research about whether it is common practice in other hospitals for RNs to perform this task. My feeling is that if I am qualified to start an IV in a scalp vein, I can probably handle a heel prick, and I can make it easier on the babe by using EMLA and hot packs before even attempting the procedure. Who does screening in your hospital?

Who does PCX/Accuchecks etc. and blood glucose draws in your hospital?

[palesarah]

I realized I didn't say much in my post so I though I'd add a few details... RNs (or occasionally, students/externs working with an RN) do the PKUs after baby is 24 hours old, and it is preferred to wait until after 48 hours or as close to that as we can get. But it has pretty much become a "night shift" duty, so unless we know that there is either a new nurse who needs the practice or that students will be on the floor the next day, we do them at night, as close to 48 hrs out as we can. (Our SVDs stay 2 nights, and our C/S stay 3 nights; we often frequently discharge mom and keep baby as a patient an extra night to work on breastfeeding if they need it). Not all nurses use sucrose but I ALWAYS do- it is new to our floor, most only use it for circs but I always use it for PKUs, bilis, etc- I have found it to work well for some babies, not as well for others; but extremely well for any baby when I swaddle leaving just that leg out and manage to have an extra person around to let them suck on a gloved finger along with the sucrose solution.

We do occasionally get patients who want an early discharge, most are fine with staying at least 24hour so we can do the PKU but if we ever get another patient asking for a 12-hour discharge and a lab slip to bring the baby in for a PKU in a few days (that idea didn't fly with our peds, who I think got the hospital attorney involved) I'll run by the idea of having them do the PKU at the home visit. They do heelsticks for bilis and all worked in LDRP before going into home health nursing so they are compatent- what a great idea (Thanks Fiona, I think you posted that it was done that way on your unit?)

[Spidey's mom, ADN, BSN, RN]

Lab does it. We are a very small hospital. We usually only have one baby at a time.

steph

[Gompers, BSN, RN]

We do all our own labs. I can't imagine letting the lab techs get anywhere near one of our babies!!!

[tasharn]

Lab does not draw our babies, The lpn or the rn draw the pku

[BETSRN]

I work in a small rural hospital as a Perinatal Nurse. It has always been the hospital policy to call a lab tech in to draw blood for PKU screening before discharge. Several of us would prefer to do the heel pricks ourselves, as it would save time if we could test the babes rather than wait for lab to come around after our moms get a discharge order. Management is all for it, as are the lab people, however, before we can write a policy, we need to do some research about whether it is common practice in other hospitals for RNs to perform this task. My feeling is that if I am qualified to start an IV in a scalp vein, I can probably handle a heel prick, and I can make it easier on the babe by using EMLA and hot packs before even attempting the procedure. Who does screening in your hospital?

We are a small community hospital. We do all our own lab draws for everything. Don't waste your time with EMLA cream. Just do the sticks. EMLA cream is not going to take away the discomfort of you having to squeeze the heel to do the PKU and CF.

[BETSRN]

Originally Posted by USA987

We also do our own after 24 hrs. of age. BUT it is the discharging RN's responsibility to look it up in the computer and ensure that the lab has received if. If you send a baby home without the PKU being done it's a mandatory DAY OFF WITHOUT pay!!

Have they ever done that? I can't imagine paying a fine for something like that!

If lab is coming for an am draw, they will do our PKU's which are ordered to be done before day 6. The RN's and LVN's do the pp ones during the night, before discharge.

We don't use EMLA on the newborns. Sometimes we use sucrose, depends on the nurse.

Originally Posted by dawnbee

I work in a small rural hospital as a Perinatal Nurse. It has always been the hospital policy to call a lab tech in to draw blood for PKU screening before discharge. Several of us would prefer to do the heel pricks ourselves, as it would save time if we could test the babes rather than wait for lab to come around after our moms get a discharge order. Management is all for it, as are the lab people, however, before we can write a policy, we need to do some research about whether it is common practice in other hospitals for RNs to perform this task. My feeling is that if I am qualified to start an IV in a scalp vein, I can probably handle a heel prick, and I can make it easier on the babe by using EMLA and hot packs before even attempting the procedure. Who does screening in your hospital?

Who does PCX/Accuchecks etc. and blood glucose draws in your hospital?

The PKU is a state mandate.

[USA987, MSN, RN, NP]

Originally Posted by USA987

We also do our own after 24 hrs. of age. BUT it is the discharging RN's responsibility to look it up in the computer and ensure that the lab has received if. If you send a baby home without the PKU being done it's a mandatory DAY OFF WITHOUT pay!!

Have they ever done that? I can't imagine paying a fine for something like that!

Yes, they have done it. Fortunately only once in the last 5 yrs. The Neonatal Newborn screening is state mandated. I don't know if our facility had problems sending them home in the past without it being done, but I imagine that is why we have the policy in place. I am sure 99.99% of parents are responsible enough to bring the baby into the lab to have it done, but what about the other .01%??

[BETSRN]

Yes, they have done it. Fortunately only once in the last 5 yrs. The Neonatal Newborn screening is state mandated. I don't know if our facility had problems sending them home in the past without it being done, but I imagine that is why we have the policy in place. I am sure 99.99% of parents are responsible enough to bring the baby into the lab to have it done, but what about the other .01%??

Here in CT, we have a refusal waiver that the parents sign BEFORE they leave the hospital and a copy of it is sent to the state. Otherwise, the hospital is fined big bucks. It is then up to the parent to wither have it done at the MD's (most do) or they just refuse in general. Those people are far and few between.

[USA987, MSN, RN, NP]

Here in CT, we have a refusal waiver that the parents sign BEFORE they leave the hospital and a copy of it is sent to the state. Otherwise, the hospital is fined big bucks. It is then up to the parent to wither have it done at the MD's (most do) or they just refuse in general. Those people are far and few between.

That's a smart idea because it then releases the hospital from any liability. :flowersfo

[SmilingBluEyes]

Here in CT, we have a refusal waiver that the parents sign BEFORE they leave the hospital and a copy of it is sent to the state. Otherwise, the hospital is fined big bucks. It is then up to the parent to wither have it done at the MD's (most do) or they just refuse in general. Those people are far and few between.

same here.

[Mimi2RN, ASN, RN]

Yes, they have done it. Fortunately only once in the last 5 yrs. The Neonatal Newborn screening is state mandated. I don't know if our facility had problems sending them home in the past without it being done, but I imagine that is why we have the policy in place. I am sure 99.99% of parents are responsible enough to bring the baby into the lab to have it done, but what about the other .01%??

I know that the PKU is State mandated. We have around 350 deliveries a month, and I know that they have been missed and a quick f/u has been done. The optimal timing is day 6, so there is time for that.