Guidance

Newborn hearing screening: learning from screening incidents

Published 21 June 2021

Applies to England

Failsafe in screening programmes

When things don’t go as planned, failsafe processes help to identify these in real time so that action can be taken before harm occurs. Let’s look at the example below:

Baby Russell was discharged home within 2 hours of birth, to the care of the community midwives from a neighbouring maternity hospital. The midwife completing the birth registration process inadvertently marked baby Russell as a stillbirth. Information about the baby did not appear in the national NHSP IT system SMaRT4Hearing (S4H), which receives information on live born babies.

The NHSP service in the birth unit did not check the local birth registers and did not realise that baby Russell had been born and then discharged home. As a result, the neighbouring NHSP site that was responsible for the baby was not aware of the need to screen the baby. The baby’s hearing screening status was not checked by the midwifery team or health visitor. At 15 weeks of age, the parents raised concerns with their GP about their baby’s hearing. The baby was referred to audiology and a diagnosis of permanent childhood hearing impairment was made.

Do you check your records against the local birth register to make sure that you have identified all babies within your responsibility that need screening?

Do you check that every birth has a NHS number is generated?

Baby Russell was diagnosed with permanent childhood hearing impairment when he was 6 months of age. If he had been screened by 4 to 5 weeks of age this would have prevented this delay in diagnosis. Finding out early can give these babies a better chance of developing language, speech, and communication skills.

We know from screening safety incidents reported, that some providers are not checking the status of babies along the screening pathways. Or that they have unclear processes for communicating the need for hearing screening when babies transfer care from one provider to another.

For failsafe processes to be effective, they must be timely.

Learning scenarios

We provide the following real scenarios to demonstrate situations where the screening pathway was not delivered as specified. We hope that you will be able to use these scenarios to look at your local pathway and confirm that you have failsafe processes or to address any gaps that may exist.

Contacting parents of a deceased baby to offer hearing screening

Scenario 1

A baby was stillborn but registered as a live birth.

Scenario 2

An NHSP site was not informed following a baby’s death in an out-of-area neonatal unit.

Scenario 3

A baby is referred to audiology but dies before the appointment.

In these scenarios the parents of the baby that has died were contacted to offer NHSP screening, causing them distress.

Do you have communication processes to make sure that information about a baby’s death is shared between providers to prevent parents of a baby that has died being contacted to offer NHSP screening or audiology follow-up?

Not following the correct NHSP protocol

Scenario 4

A baby was screened in hospital and referred to audiology with ‘bilateral no clear response’. Routine data reports highlighted that the baby had not attended the audiology appointment and the newborn hearing screening record was deactivated, with a reason of ‘clear responses’ at screening. Further investigation revealed that the screening result was not recorded in the personal child health record (PCHR) and the baby’s screen was incorrectly repeated by health visitor during a home visit where ‘bilateral clear responses’ were obtained.

Scenario 5

A baby with bacterial meningitis should have had a diagnostic referral made. This was unnoticed by the screener and routine newborn hearing screening was undertaken. The baby had clear responses at the screen and was not referred.

Scenario 6

Baby had newborn hearing screen (well baby protocol) with ‘clear responses’ but was later admitted to neonatal intensive care units for 3 days. Repeat screen, in line with neonatal intensive care unit (NICU) protocol, was not completed.

In these scenarios that baby has not had the correct screening test. This means that there may be a delayed or missed diagnosis of hearing impairment.

Do you make sure that all babies are on the correct NHSP protocol? This includes the correct identification of babies with contra-indications to screening, progression onto the next stage of the screening protocol when a ‘bilateral no clear response’ is found and ensuring that all babies admitted to NICU for 48 hours or more are screening on the NICU protocol.

QA checks on screening equipment

Scenario 7

A screener fails to perform the QA checks on equipment which is then used to screen babies. Routine calibration of the equipment shows there is a fault which would have been picked up by a QA check. Babies screened with the equipment need to be recalled.

Do you have a systematic process in place to make sure that QA checks are performed on equipment before it is used to screen babies?

Missed offer of screening for babies in different settings

Scenario 8

A baby is transferred to an out of area specialist children’s hospital from the local neonatal unit. The maternity service where the baby was born does not inform the local NHSP service that the baby has been transferred and the record is not updated on S4H. The specialist children’s hospital does not check that the baby has had newborn hearing screening prior to transfer. The NHSP programme local to the specialist children’s hospital is unaware that the baby has been transferred.

Do you check that all babies within your responsibility are screened?

Do you make sure that if babies are transferred out of area, arrangements are agreed for the completion of hearing screening?

Safeguarding or consent issues

Scenario 9

A parent complains that their baby has been screened without them present and that they did not give permission for the screen.

Scenario 10

A baby in local authority care is screened without the correct consent being obtained

Scenario 11

A mother does not speak English as a first language. Her baby is screened but her partner later complains that his wife did not understand what was happening and is unclear about the results of the screen.

Do you make sure that you have consent to screen a baby?

Do you make sure that the parent understands the information being provided and that you can access appropriate language support if they do not understand English?

Audit of the NHSP failsafe pathway

In addition to keeping S4H up to date and reviewing the nationally provided reports you can also check your failsafe processes by audit. Example of audits that you can complete include checking:

• timeliness of communication pathways when a baby dies
• that audiology referrals have completed within the recommended timeframes and recorded on S4H
• that consent or decline of S4H screening is recorded
• that screening information has been provided
• that screening results are discussed and that this is documented
• babies that ‘did not attend’ or ‘was not brought’, focusing on health inequalities and checking that your services are meeting the needs of protected groups