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This publication is available at https://www.gov.uk/government/publications/newborn-and-infant-physical-examination-programme-handbook/newborn-and-infant-physical-examination-screening-programme-handbook
1. Background and purpose
The guidance in this handbook relates to the screening elements undertaken as part of the holistic head-to-toe examination of the baby. Any reference to the newborn and infant physical examination (NIPE) examination in this document relates to the 4 screening elements only.
Although included in the earlier version of the NIPE standards and competencies (2008), the competencies and 6 to 8 week standards have been removed from national standards as there is no way of systematically measuring these. This document includes good practice guidance and recommended referral timescales to support a high quality local 6 to 8 week NIPE infant examination screening service until there is a robust method of measuring and reporting these standards.
The UK National Screening Committee (UK NSC) recommends that all eligible babies should be offered the NIPE screen. The screen should be undertaken and completed within 72 hours of birth and then again at 6 to 8 weeks of age.
The NHS NIPE Screening Programme aims to reduce morbidity and mortality by:
- identifying and referring all children born with congenital abnormalities of the eyes, heart, hips, and testes, where these are detectable, within 72 hours of birth
- identifying those abnormalities that may become detectable by 6 to 8 weeks of age, at the second physical examination
The screening elements of the NHS NIPE Programme are:
- Eyes: approximately 2 or 3 in 10,000 babies have problems with their eyes that require treatment. The prime purpose of screening is to identify congenital cataracts.
- Heart: approximately 4 to 10 in 1,000 babies have a heart problem.
- Hips: approximately 1 or 2 in 1,000 babies have hip problems that require treatment.
- Testes: approximately 1 in 100 baby boys have problems with their testes that require treatment.
The above incidence rates are derived from best estimates of national and regional historical data. These will be revised in due course when better data becomes available.
1.1 Information for parents
Screening providers should use information in the Screening tests for you and your baby booklet to tell parents about the newborn and 6 to 8 week infant physical examinations during the antenatal period and again before the newborn examination is offered.
Parents should be informed of findings at the time of each examination and advised to report any concerns they have about their baby’s wellbeing to a healthcare professional at any time.
1.2 Record keeping
Providers should obtain verbal consent for screening.
You should clearly record each screening examination and the outcome of each examination in:
- the baby’s clinical notes
- local clinical data collection system and/or the NIPE Screening Management and Reporting Tool (NIPE SMART) IT system or GP IT system
- personal child health record (PCHR)
There should be:
- local arrangements to ensure all screen positive babies are referred and seen in line with national standards.
- robust and regular feedback of results from screening referrals (to ensure newborn babies with a positive screen are seen by a specialist within the required referral timeframe)
- a local process to follow up all non-attendance of appointments after referral
Screen positive babies who are born in hospital and require senior paediatrician referral (for heart and bilateral undescended testes) should have this completed within 24 hours of the examination or before discharge (whichever is sooner) and the outcome set on NIPE SMART.
Referral outcome relates to:
Date or time of attendance at post referral appointment or when seen by senior paediatrician (to calculate concordance with national standards , completion of the screening pathway and to assure failsafe process). This is critical information.
Final diagnosis to assess programme performance (true positive or false positive).
2. NIPE screening pathways
See Appendix A for NIPE newborn pathway and Appendix B for NIPE infant pathway.
3. The screening tests
3.1 NIPE newborn examination
This examination should take place within 72 hours of age. It is recommended it should take place before transfer home (unless a home birth). This maximises the opportunity for completing the examination within 72 hours. Local arrangements should be in place to meet national timescales when babies transfer home before undertaking the NIPE examination or when babies transfer from one acute provider to another.
All newborn babies will be eligible for the NIPE newborn examination at some point, unless they die. The examination should take place within 72 hours, or as soon as possible after this time. Screening may be delayed if it is not the clinical priority, for example if the baby is too premature or unwell to have the examination, but screening should be completed as soon as the baby’s condition allows. These babies should be accounted for with the reason for the delay explained as mitigation against the 72-hour performance threshold.
Babies identified as not having received a NIPE newborn examination should be followed up locally and the examination undertaken as soon as possible. These include ‘movers in’ and those previously too ill to be screened.
Key performance indicator (KPI) data should be counted where the maternity service is responsible for the baby at the time of newborn screening, including babies who have moved out after they were screened and received a result.
Babies who move in before screening are the responsibility of the receiving provider and should be included in their KPI coverage data. KPI data should be derived on this basis.
Please note that KPI NP1 measures coverage of babies up to 72 hours of age and therefore does not capture all babies born in England having a NIPE examination.
Babies remain eligible for newborn examination until 6 weeks of age but the examination should be completed as close to 72 hours of age as possible.
The responsibility for identifying eligible babies remains with the birth unit until responsibility is formally passed to another provider (acute or primary care). Ideally this should be managed using the NIPE SMART IT system.
Following the newborn examination, all results should be recorded and parents informed of the outcome with an explanation of referral process if required, including expected appointment timescales. They should also be informed that the NIPE infant examination will be undertaken at 6 to 8 weeks of age as some conditions can develop or become apparent later.
The outcomes that should be recorded for screen positive babies are:
- hip screen positive (clinical examination) – undergo hip ultrasound by 2 weeks of age
- presence of hip risk factors – undergo hip ultrasound by 6 weeks of age
- eye screen positive – seen at ophthalmology appointment by 2 weeks of age
- bilateral undescended testes – senior paediatrician review within 24 hours of the newborn examination
- heart screen positive – senior paediatrician review (urgency depends on suspected condition) but review is recommended before discharge home
- NIPE newborn examination should take place within 72 hours of age.
- It is considered safer to undertake the NIPE newborn examination early with the potential for more false positives, rather than risk missing screening altogether.
- In the case of early transfer home, babies should still be offered a NIPE newborn examination and the need for this should be communicated to the appropriate clinician at handover. Ideally, the examination should take place in hospital before transfer home. If this does not happen before transfer, there must be a robust local follow-up pathway to ensure it takes place within 72 hours of age. This could be by return to a designated NIPE clinic or arrangements being made for the examination to take place in the community/primary care setting.
- It is the responsibility of the maternity service providing care to ensure the NIPE newborn examination is provided for babies born at home
- Screening may be delayed if a baby is too premature or too unwell to have the examination (that is, if screening is contraindicated).
- Each element of the NIPE screening should be completed as and when the baby’s condition allows.
- If any one (or more) of the 4 screening elements do not take place for any reason, the NIPE newborn examination’s remaining screening elements should still take place and the outstanding elements of the examination should be completed as soon as feasible. When reporting on KPIs, these babies should be accounted for and the reason explained in the commentary as exceptions and mitigations against any performance thresholds.
- Babies remain eligible for newborn examination until 6 weeks of age but the examination should be completed as close to the 72-hour time period as possible. This includes unscreened babies who ‘move in’.
- Eligible babies who move into the area who have not been screened should be offered a screen by the responsible service provider in their new area of residence. This may be by the maternity, neonatal service or in primary care depending on the age of the baby – for these babies screening results will, in practice, only be recorded on NIPE SMART if the NIPE examination is undertaken by the maternity service. The transferring service should formally hand over responsibility and communicate this to the receiving care provider.
Babies in neonatal units
Babies in neonatal units should be assessed and if well enough the NIPE screen should take place within 72 hours of age.
Some babies in neonatal units may be too ill at the time the examination is due and the NIPE screen is not appropriate. If possible all screening elements should be undertaken but, if not, each element of the NIPE screen should be completed as soon as practicable.
Some elements of the NIPE screen may need to be repeated in very preterm babies (for example, eyes) but referrals should still be made as per national standards regarding screen positive cases.
Referral timescales should not be age adjusted for preterm babies.
Babies less than 32 weeks gestational age (up to 31 weeks and 6 days) or less than 1500g birthweight should be screened for retinopathy of prematurity (ROP).
3.2 6 to 8 week infant examination
Information about the 6 to 8 week infant physical examination should be given to the mother during the postnatal period and again before the infant examination being offered.
This examination take place in a community setting (usually by the GP) between 6 and 8 weeks of age.
There should be timely checks to ensure the following:
- All eligible babies are offered screening (including those who move into the area).
- The examination takes place between 6 and 8 weeks of age.
- Any required referrals are made within the timescales outlined below.
- Follow-up of referrals to ensure appropriate interventions have taken place as required.
- If the baby is screen positive for any element of the newborn examination, the practitioner undertaking the 6 to 8 week examination should check the progress along the care pathway to ensure required actions take place.
4. Examination of the eyes
Please note that the guidance below relates to both newborn and 6 to 8 week infant examination unless otherwise stated.
Approximately 2 or 3 in 10,000 babies have problems with their eyes that require treatment. The prime purpose of screening is to identify congenital cataracts.
4.2 Associated risk factors
NHS NIPE programme risk factor is:
- family history of congenital or hereditary cataracts (first degree relative)
Additional risk factors are:
- children with trisomy 21 who have a high risk of ophthalmological disorders and should have continued surveillance
- maternal exposure to viruses during pregnancy, including rubella and cytomegalovirus
Although the primary purpose of screening is to identify congenital cataracts, local pathways should be followed for any additional risk factors or incidental findings, including the presence of aniridia1, colobomata2 and retinoblastoma3.
4.3 Undertaking the examination
Before the examination practitioners should establish:
- mother’s recent obstetric history
- baby’s family history (childhood eye disorders, particularly congenital cataract).
Bilateral examination covers:
- eye opening – presence of eyes
- position and symmetry
- size and colour
- presence of red reflex (a reflection from the back of the eye that is similar to the red eye effect sometimes seen in flash photography)
If no red reflex, or a weak red reflex, is seen, it may mean there is cloudiness in the lens.
6 to 8 Week infant examination
In addition to the above, observe eye movement and fix and follow response.
4.4 Screen negative – newborn and 6-8 week infant examination
If no abnormality is detected, transfer care to the Healthy Child Programme.
Parents should be advised to contact their midwife, GP or health visitor if they have concerns about their baby’s eyes, for example, if:
- their baby does not open their eyes and focus or does not follow small movements
- the baby’s eyes look unusual
- there is a lack of ‘red eye’ in one eye in a photograph of their baby.
Babies with neurological/neurodevelopmental conditions or sensorineural4 hearing impairment and babies with chromosomal abnormalities, such as Trisomy 21, will require regular monitoring, even if the examination shows no evidence of an ocular problem.
4.5 Screen positive
The absence of red reflex suggests the presence of a congenital cataract.
A white reflex (leukocoria) suggests a tumour of the eye (retinoblastoma)
Screen positive following newborn examination
Babies with an abnormality of the eye identified at the newborn examination should attend an assessment appointment by 2 weeks of age. This assessment should be with a consultant ophthalmologist/paediatric ophthalmology service.
Screen positive following 6 to 8 week infant examination
These infants should be referred to consultant ophthalmologist/paediatric ophthalmology service for expert opinion and they should be seen by 11 weeks of age.
5. Examination of the heart
The overall incidence of congenital heart defects (CHDs) is 4 to 10 per 1,000 live births ranging from non-significant to major and critical lesions. Critical or major congenital cardiac malformations are found in approximately 2 to 3 per 1,000 live births and are a leading cause of morbidity and mortality in the neonatal period and beyond.
Congenital heart abnormalities can be categorised as:
- critical CHD: includes all potentially life threatening duct-dependent conditions and those conditions that require procedures within the first 28 days of life
- major serious CHD: those defects not classified as critical but requiring invasive intervention in the first year of life
Some critical and major cardiac lesions may be detected during pregnancy as part of the fetal anomaly screening programme (FASP) during the fetal anomaly ultrasound scan. The acceptableFASP standard target detection rate for specific cardiac abnormality is ≥50%.
5.2 Associated risk factors
The NHS NIPE programme risk factors are:
- family history of congenital heart disease (first degree relative)
- fetal trisomy 21 or other trisomy diagnosed (these babies have high risk of cardiac defects and require continued surveillance)
- cardiac abnormality suspected from the antenatal scan.
Other risk factors associated with CHD are:
- maternal exposure to viruses, for example, rubella during the first trimester of pregnancy,
- maternal conditions, such as diabetes (type 1), epilepsy, systemic lupus erythematosis (SLE)
- drug-related teratogens during pregnancy, for example, antiepileptic and psychotrophic5 drugs
5.3 Undertaking the examination
Before the examination practitioners should establish relevant information regarding:
- mother’s medical and recent obstetric history including any medication
- baby’s family history
- baby’s immediate postnatal health
Parents should be asked if:
- the baby ever gets breathless or changes colour at rest or with feeding
- the baby’s feeding behaviours and energy levels are normal
- the baby is ever too tired to feed, quiet, lethargic, or has poor muscle tone
- general tone
- central and peripheral colour
- size and shape of chest
- respiratory rate
- symmetry of chest movement, use of diaphragm and abdominal muscles
- signs of respiratory distress (recession/grunting)
- femoral and brachial pulses for strength rhythm and volume
- assessment of perfusion through capillary fill time
- position of cardiac apex (to exclude dextrocardia)
- palpation of liver to exclude hepatomegaly – may be present in congestive heart failure
- +/- thrill
- presence of a murmur – systolic / diastolic – loudness
- quality of heart sounds at the following 5 sites:
- second intercostal spaces adjacent to the sternum: left (pulmonary area)
- second intercostal spaces adjacent to the sternum: right (aortic area)
- lower left sternal border in the 4th intercostal space (tricuspid area)
- apex (mitral area)
- midscapulae (coarctation area)
5.4 Screen negative
If no abnormality suspected, transfer care to the Healthy Child Programme.
Parents should be advised to contact their healthcare professional or emergency services if they have any concerns about their baby.
5.5 Screen positive
Babies with screen positive clinical findings should be seen by a senior pediatrician with expertise in cardiology in the early neonatal period as required (urgency will depend on suspected condition).
Signs and symptoms that suggest critical or major congenital heart abnormality are:
- tachypnoea at rest
- episodes of apnoea lasting longer than 20 seconds or associated with colour change
- intercostal, sub-costal, sternal or supra-sternal recession, nasal flaring
- central cyanosis
- visible pulsations over the precordium, heaves, thrills
- absent or weak femoral pulses
presence of cardiac murmurs/extra heart sounds:
- significant murmurs are usually loud, heard over a wide area, have a harsh rather than soft quality, and are associated with other abnormal findings
- benign murmurs are typically short, soft, systolic, localised to the left sternal border, have no added sounds or other clinical abnormalities associated with them
The examining practitioner should discuss findings with a senior paediatrician or a paediatrician with expertise in cardiology and refer as appropriate. Urgency will depend on the assessment of the clinical condition of the baby.
Many babies will have cardiac murmurs in the first 24 hours of life in the absence of a cardiac defect (linked to physiological changes at birth). However, cardiac murmurs may be absent in babies with a significant cardiac defect.
5.6 Cardiac standards
These may be developed at a later date and may include the findings and outcomes of the national newborn pulse oximetry pilot study.
6. Examination of the hips
The guidance below relates to both newborn and 6 to 8 week infant examination unless otherwise stated.
Approximately 1 or 2 in 1,000 babies have hip problems that require treatment.
Undetected developmental dysplasia of the hips (DDH) or delayed treatment may result in the need for complex surgery and/or long-term complications such as:
- impaired mobility and pain
- osteoarthritis of the hip and back
Early diagnosis and intervention will improve health outcomes and reduce the need for surgical intervention.
6.2 National hip risk factors
The NHS NIPE programme national hip risk factors are:
- First degree family history of hip problems in early life. This includes baby’s parents or siblings who have had a hip problem that started as a baby or young child that needed treatment with a splint, harness or operation.
- Breech presentation at or after 36 completed weeks of pregnancy, irrespective of presentation at birth or mode of delivery. This includes breech babies who have had a successful external cephalic version (ECV).
- Breech presentation at delivery if this is earlier than 36 weeks gestation.
For babies with any of the above risk factors, hip ultrasound examination should be arranged and in the case of multiple births with these risk factors, all babies in the pregnancy should have a hip ultrasound examination.
The rationale for this advice is that if one of the babies meets the criteria of breech presentation, as described above, it may be difficult to accurately identify which baby was affected.
6.3 Undertaking the examination
Before the examination practitioners should establish:
- mother’s recent obstetric history
- baby’s family history
- national hip risk factors
The examination should take place in a warm environment and on a firm flat surface with the baby undressed and settled.
- symmetry of leg length
- level of knees when hips and knees are both flexed
- symmetry of skin folds in the groin when baby is in ventral suspension6
- if legs can be fully abducted
Undertake both the Ortolani and Barlow manoeuvres on each hip separately to assess hip stability.
Ortolani manoeuvre is used to screen for a dislocated hip.
Barlow manoeuvre is used to screen for dislocatable hip.
6.4 Screen negative
If no abnormality is detected, transfer care to Healthy Child Programme.
Parents should be advised to contact their midwife, GP or health visitor if they have concerns about their baby’s hips. In particular they should observe if:
- one leg cannot be moved out sideways as far as the other when changing the baby’s nappy
- a difference in the deep skin creases of the thighs between the 2 legs
- one leg seems to be longer than the other
- a click can be felt or heard in one or both hips
- one leg drags when their baby starts crawling
- their child walks with a limp or has a ‘waddling’ gait
6.5 Screen positive
Screen positive results are:
- difficulty in abducting the hip to 90 degrees
- difference in leg length
- knees at different levels when hips and knees are bilaterally flexed
- asymmetry of groin skin folds
- palpable ‘clunk’ when undertaking either the Ortolani or Barlow manoeuvres
These babies should be referred and undergo hip ultrasound within 2 weeks of birth.
Screen negative examination with risk factors
Babies who have presence of national hip risk factors but a normal newborn clinical hip examination should be referred and undergo hip ultrasound by 6 weeks of age.
Good practice includes:
provision of a ‘one stop shop’ model in which ultrasound and orthopaedic appointment is undertaken on the same day during the same care and is likely to lead to more timely orthopaedic referral
local processes, where NIPE SMART is implemented, to ensure the dates of the ultrasound scan and orthopaedic appointment are both recorded on the system
6.6 Screen positive following 6 to 8 week infant examination
Infants should be referred directly to orthopaedic surgeon for urgent expert opinion and be seen by 10 weeks of age.
7. Examination of the testes
Cryptorchidism affects approximately 2 to 6% of male babies born at term. It is associated with:
- a significant increase in the risk of testicular cancer (primarily seminoma7)
- reduced fertility when compared with normally descended testes
- other urogenital problems such as hypospadias and testicular torsion
Bilateral undescended testes in the newborn may be associated with ambiguous genitalia or an underlying endocrine disorder such as congenital adrenal hyperplasia.
Early diagnosis and intervention improves fertility, reduces the risk of torsion and may aid earlier identification of testicular cancer.
7.2 Associated risk factors
Associated risk factors include:
- a first degree family history of cryptorchidism (baby’s father or sibling)
- low birth weight
- small for gestational age or preterm birth
7.3 Undertaking the examination
Before the examination practitioners should review mother’s recent obstetric history and baby’s family history.
Observe scrotum for symmetry, size and colour.
Carry out palpation of scrotal sac to determine location of testes bilaterally.
If testes are not located in the scrotal sac, palpation of the inguinal canal should be undertaken.
7.4 Screen negative
If no abnormality detected, transfer care to Healthy Child Programme.
Parents should be advised to contact their midwife, GP or health visitor if they have concerns about their baby’s testes.
7.5 Screen positive
Screen positive result is the absence or incorrect position of one or both testes.
Screen positive following newborn examination
Bilateral undescended testes should be seen for assessment by a senior paediatrician within 24 hours of the examination to rule out metabolic and intersex conditions.
Unilateral undescended testis should be reviewed at 6 to 8 week examination.
Screen positive following 6 to 8 week infant examination
Bilateral undescended testes should be seen by a senior paediatrician within 2 weeks of the examination.
In cases of persistent unilateral undescended testis:
- GP to review between 4 and 5 months of age
- refer to surgeon if testis still absent
- to be seen no later than 6 months of age
8. Maintaining competency in undertaking NIPE examinations
All healthcare professionals have a personal professional responsibility to maintain competency. There is also an organisational responsibility to ensure a safe and competent workforce.
Those who undertake newborn and infant physical examinations must work in a framework of professional accountability. Each practitioner is responsible for maintaining their own competence to carry out the examination to the highest standard and for the identification of gaps in knowledge and training needs.
In order to provide duty of care, the examinations must be carried out by an appropriately trained health professional:
This must be done by a doctor (paediatrician or GP) who is competent to undertake all elements of the newborn examination or a midwife, nurse or health visitor who has successfully undertaken a university-accredited ‘examination of the newborn’ programme of study and has also undergone locally agreed competency assessment by a practising NIPE examiner.
This must be done by a doctor who is competent to undertake all elements of the 6 to 8 week NIPE examination. Please note that not all trainee GPs undertake formal paediatric training, so it is important that NIPE is covered in their GP attachment (ST3 year).
A health visitor or nurse with suitable competency may undertake the infant examination. To be considered competent a health visitor or nurse is expected to undertake a university-accredited examination of the newborn course (as elements of the course content would also be relevant for the examination at 6 to 8 weeks) and have also undergone locally agreed competency assessment by a practising NIPE examiner.
Best practice recommendations
We recommend there should be a local competency assessment process in place that considers the best practice recommendations below. The focus should not be on a minimum number of examinations but on the quality of the examination performed.
- Consider implementation of local mandatory assessment of clinical competencies for all healthcare professionals who conduct the newborn and 6 to 8 week physical examinations.
- Provide a local annual update for those who undertake the NIPE examination. This may include practical and theoretical assessment and annual completion of the NIPE e-learning module. E-learning for Healthcare registration and a password are required to access the resource.
- Local providers may choose to determine and set minimum numbers of examinations but this is not a programme requirement.
- Institutes of higher education that provide the examination of the newborn module may recommend the numbers of examinations to be performed as part of the module curriculum.
- Trusts that have a locally delivered training course for practitioners to undertake examination of the newborn examination are responsible for managing any risk associated with this approach. Trusts should seek university accreditation for such in-house training courses.
9. Babies who have missed NIPE screening
The following clinical guidance outlines the appropriate screening tests depending on age for babies found to have missed NIPE screening. If the missed screen is as a result of a screening pathway failure then actions should be taken in line with national screening incident guidance.
9.1 Classification of missed newborn examination
The optimum time for NIPE newborn screening examination is within 72 hours of age. If not completed within 72 hours, it should be undertaken as soon as possible after this time.
Babies that are too ill to have the screen within 72 hours should be managed as an exception for purposes of performance data. All babies remain eligible for the NIPE newborn examination until 6 weeks of age.
It is expected that all babies should have all elements of the NIPE newborn examination undertaken before being fully discharged from the care of any maternity, neonatal or paediatric inpatient services.
A NIPE newborn examination is classified as ‘missed’ if it is not completed:
- before full discharge from maternity services or neonatal or paediatric inpatient services (without provision for completion within the community setting)
- by 6 weeks of age for unscreened babies who remain in maternity or neonatal inpatient care
- by 6 weeks of age for unscreened babies who have moved into an area
At 6 weeks of age babies then become eligible for the 6 to 8 week infant examination.
9.2 Movers in and out
Babies who move in or out of an area are at higher risk of missing screening and robust methods of identification and follow-up should be in place.
9.3 Infants up to and including 3 months of age
- The optimum time for NIPE newborn screening is within 72 hours of age. NIPE newborn examinations undertaken outside 72 hours of age should be completed as soon as possible after this time
- Babies remain eligible for newborn examination until 6 weeks of age but the examination should be completed as close to the 72-hour time period as possible. This includes unscreened babies who ‘move in’
- Eligible babies who move into the area who have not been screened should be offered a screen by the responsible service provider in their new area of residence. This may be by the maternity, neonatal or paediatric services or in primary care depending on the age and condition of the baby – for these babies screening results will, in practice, only be recorded on NIPE SMART if the NIPE examination undertaken is by the maternity or neonatal services. The transferring service should formally hand over responsibility and communicate this to the receiving care provider.
- If NIPE screening is performed at or after 6 weeks of age, it is not necessary to undertake it again.
- If the 6 to 8 week NIPE infant examination is overdue it should be undertaken as soon as possible.
9.4 Children older than 3 months of age
- If the 6 to 8 week NIPE infant examination has not been performed it should be undertaken as soon as possible.
- Examination for DDH using the Barlow and Ortolani manoeuvres is no longer accurate at this age.
- Any asymmetry of leg length or hip abduction should be sought and the child’s gait should be observed.
- In line with advice in the PCHR, parents should be advised to contact their GP or health visitor if they have any concerns regarding their child’s wellbeing.
9.5 Undertaking a missed NIPE examination
The relevant examination or observation must be undertaken by a suitably qualified practitioner.
10. Quality assurance
The NIPE screening programme has a defined set of standards that providers must meet to ensure local services are safe and effective. Quality assurance (QA) is the process of checking these standards are met and encouraging continuous improvement. It includes:
- advising on the development of national quality standards
- monitoring how services meet (or fail to meet) standards
- providing expert screening advice for incident management
- facilitating quality review of services, including peer advice in supporting those involved in commissioning or providing screening services
QA covers the entire screening pathway from identifying who is eligible to be invited to screening to referral where required.
The aim of QA is to maintain minimum standards and drive continuous improvement in the performance of all aspects of screening to ensure all women and their babies have access to high quality screening wherever they live.
QA is essential in order to minimise harm and maximise benefits of screening.
Formal QA visits to local screening programmes provide the forum for a peer review of the whole multidisciplinary screening pathway. Regional QA teams advise providers and commissioners about reducing risks in local screening services. They assess the strength of local arrangements through audit, as part of peer review and in the investigation of any incidents as they occur. They helps share information and best practice at national, regional and local levels.
Participation in a formal process of QA is the responsibility of each local screening provider. The performance of the local services is monitored in a variety of ways such as review of statistics, regional meetings or informal visits.
10.1 Key performance indicators
KPIs provide a way of measuring screening programme performance in specific areas. They contribute to the overall quality assurance of screening programmes but are not sufficient to fully quality assure or performance manage screening services. KPIs help local screening services identify potential or actual problems so remedial actions can be taken.
10.2 Coverage data and failsafe
Coverage performance data helps ensure safe and inclusive local delivery of the NIPE programme.
This data can be reported using NIPE SMART to inform submissions and should be calculated in line with national guidance.
It is not possible to provide robust coverage data for England as the complete cohort cannot be assured, particularly for babies who move from one provider to another. Use of the national NIPE SMART IT system or future use of automated feeds from provider systems will support complete cohort identification, failsafe and robust reporting.
10.3 NIPE KPI process guidance
Reporting focus maternity service
Principles and process are as follows:
- The NIPE programme produces quarterly reports that are uploaded and available on NIPE SMART.
- Trusts using NIPE SMART use this data in their KPI submission. Trusts should review the nationally provided monthly NIPE KPI reports and follow up babies identified as ‘not screened’ or who have not attended for post referral appointment (KPI breaches). This will help improve data quality. These reports should also be reviewed and discussed at local programme boards.
- Before data submission, mitigation information may be taken into consideration and additional data added. This may reflect NIPE screening activity that is not recorded on NIPE SMART for whatever reason, for example, newborn 72-hour examinations undertaken by GPs in primary care settings or neonatal units.
- All trusts (with and without NIPE SMART) should submit data via the maternity services template.
Trusts should ensure there are local systems for entering all relevant coverage and outcome data on to NIPE SMART including date of post screen positive referral appointment / review.
Trusts should seek to add all NIPE screening and outcome data to NIPE SMART to:
- reflect completion of the whole screening pathway
- reflect programme performance
- assure failsafe
Where NIPE examinations take place in primary care, local feedback mechanisms should be developed and agreed so screening results are entered on to NIPE SMART in a timely fashion.
The national programme is working towards extracting all NIPE KPI data directly from NIPE SMART.
Summary reports based on the KPI submitted data and NIPE SMART data will be produced quarterly and sent to screening and immunisation teams and the PHE screening quality assurance service (SQAS) to provide a useful overview and quarter by quarter comparison. KPI data is also reported by CCG.
Trust level KPI submission (for those that have not yet implemented NIPE SMART)
This report will be submitted by trusts directly to the NHS Screening Programmes and published on GOV.UK
PHE screening publishes KPI data reports quarterly and shares an extended KPI data set with NHS England.
10.4 Screening safety incidents
See national information about managing screening safety incidents.
10.5 NIPE standards
NIPE screening programme standards provide a defined set of measures that providers have to meet to ensure local programmes are safe and effective.
Aniridia is the absence of the iris, usually involving both eyes. It can be congenital or caused by a penetrant injury. Isolated aniridia is a congenital disorder which is not limited to a defect in iris development, but is a panocular condition with macular and optic nerve hypoplasia, cataract, and corneal changes. ↩
Colobomata is a hole in one of the structures of the eye, such as the iris, retina, choroid, or optic disc. ↩
Retinoblastoma is a rare malignant tumour of the retina, affecting young children. ↩
Sensorineural is a type of hearing loss, or deafness, in which the root cause lies in the inner ear (cochlea and associated structures), vestibulocochlear nerve (cranial nerve VIII), or central auditory processing centres of the brain. ↩
Psychotrophic means relating to or denoting drugs that affect a person’s mental state ↩
In ventral suspension the baby is draped over the supporting hand ↩
Seminoma is a germ cell tumour of the testicle or, more rarely, the mediastinum or other extra-gonadal locations. It is a malignant neoplasm and is one of the most treatable and curable cancers, with a survival rate above 95% if discovered in early stages ↩