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Protocol and Guidelines Appendices 1

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1. Aim to maximise the life of your Acoustic Transducer Assembly ATA amp Patient Cable Assembly PCA To help prevent any strain or damage on the cables during cleaning as delicate shielding in the wires can be damaged see page 100 Algo 3 Manual To help prevent corrosion of sensor clips due to the build up of sensor adhesive To help reduce any increase in myogenic interference during screening due to damaged cables Preamplifier PCA Cable Cleaning Cables 1 Gently clean Algo cables between each patient use according to your hospital protocol 2 Cables may be cleaned by using a diluted detergent based solution isopropyl alcohol or 10 bleach solution page 52 Algo 3 manual page 25 A3i manual After each patient use gently clean the PCA and ATA cables using a cloth dampened not soaked with appropriate cleaning solution Never immerse patient cables or transducers in water or cleaning solution Do not saturate the cables Do not stretch the cables during cleaning as delicate shielding in the wires can be damaged Clean PCA Cable in two steps w NOOO Hold cable at plastic clamp Found at centre of sensor cable where it divides into three Wipe gently from plastic clamp towards the sensor clips Hold cable at plastic clamp Wipe gently from plastic clamp towards the Preamp 8 Clean in between each sensor clip with an Alco wipe at the end of each shift This will prevent the build up of any residual hydro
2. poor APGARs seizures neurological Sensorineural hearing loss auditory involvement neuropathy Sensorineural hearing loss central Auditory involvement can have sudden permanent H loss effects Dry brittle flat twisted hair Sensorineural Hearing Loss Conductive sensorineural and mixed Renal anomalies auricular pits pinnae malformations hearing losses Absence of the Tibia bone Sensorineural Hearing Loss Conductive and Sensorineural Hearing Skeletal enlarged diaphysis of the long bones Loss Cisplatin Carboplatin inner ear hair cells affected Sensorineural hearing loss Hypoxic episode during development or birth asphyxia Sensorineural Hearing Loss Conductive Sensorineural Hearing Atresia stenosis of the ear channel Loss mixed Conductive Sensorineural Hearing Atresia stenosis malformation of the pinnae Loss mixed Malformation of the hard palate Exclude cleft lip if only feature present Conductive Hearing loss Coloboma eyes Heart Atresia of the nares Genital Ear Conductive sensorineural hearing loss deafness and mixed Can have aud neuropathy Conductive amp Sensorineural Hearing Retarded ossification narrowed auditory canal Loss Growth failure and neurologic delay retinal atrophy Sensorineural Hearing Loss Conductive SN or mixed hearing SGA limb malformations cardiac defects cleft palate losses Conductive SN or mixed Majority are Craniosynostosis midface anomalies outer amp middle ear defect
3. FAIL this indicates the myogenic is coming from the environment or there is a problem with the equipment may want to try and rescreen elsewhere io medics Natus ALGO3 NEWBORN HEARING SCREENER TROUBLE SHOOTING AMBIENT ENVIRONMENTAL NOISE Check Equipment Check ATA transducer cable is properly attached at back of Algo and not damaged Position each ear coupler so cables emerge towards the top of baby s head like horns Check transducers have a secure connection to ear couplers Make sure the ear couplers are sealed around the baby s ear Sometimes if the baby is on his her side the shoulder can push up on the coupler allowing ambient noise to intrude May have to hold ear coupler gently top and bottom to provide a good seal e Lights flashing in transducers indicate ambient noise Check Baby e Is the baby crying pause screening until baby settles down and ambient noise decreases Check Environment e Check the environment make sure there is not too much environmental noise Eliminate if possible and if not try and find a quieter spot e Ifthe ambient noise bar does not go down and all the trouble shooting has been addressed Go to equipment check F10 and perform an Acoustic Check MONITORING EAR COUPLERS AND FLUCTUATING PROGRESS BAR If the progress bar is constantly fluctuating or does not advance check the following e Arestless agitated baby needs to be calmed down as this will ca
4. Speech checkiat o felon You reget fred Pee weet to Corea at pour baby gees ciler Please compare you baby arbon 1 thee bat you hes any Comcerms of ay tere sheet you baby a Seawg conten the heaty Meanng Propa or poe tamh docks Hearing and Speech Checklist Birth to 3 months O Settes to tamtar sounds or voices O ts started by or jumps when there is a sudden noise 3 to 6 months O Tums head or eyes toward interesting sounds C Appears to isten O Wakes easity to sound Cs Starts to make speect tike sounds 6 to 12 months O Understands simple words such as no amp Bye bye Co Begins to copy speech sounds Cs Turns mead to sof sounds 12 to 18 months O Appears to understand more words each week C When asked points to peopie body parts or toys Cs Follows simple spoken instnuchons ie sit down Co Says two to three real words og ball dog car If you have any concerns about baby s hearing contact The Healthy Hearing Program Click amp insert hospital name Hospital Phone Click amp Insert phone number or your family doctor Revised August 2013 Review 2015 Appendix 4 Screener Scripts Summary of the Various Hearing Screen Scenarios and Key Content Areas for Inclusion Hearing Screen Scenario Purpose Key points to be included Arranging an initial Healthy Hearing Screen Parent s not familiar with Healthy Hearing Program Explain program aims amp offer screen Descr
5. please print Signature Date Page 1 of 1 Reviewed August 2013 Review 2015 Title Target Group Purpose Healthy Hearing Program To be completed for all Medico legal document used to Newborn Hearing babies regardless of o record demographic amp medical data including presence Screening amp Referral Form whether they of high risk indicators for hearing loss commence complete the o record results amp follow up actions of screen for filing in hearing screen process babies clinical charts o refer baby to Audiology amp Family Support Service o provide a template for data entry into Algo o any additional information re screening history Queensland Government Queensland Government Healthy Hearing Program Newborn Hearing Screening and Referral Healthy Hearing Program idee Newborn Hearing Screening and Referral Facility Date of dimh Sex uM Alternative contacts Ath entiication label here AABR 3 screening results Address Medical contact Additional notes MM b r 7 Date Time MAKE ALL NOTES CONCISE AND RELEVANT wy Baby s details s UR Number Hospital of birth Gestational age at birth Location of Screen MAT ICN SCN BC OPD PAED COMM OTHER Indigenows Status 1 2 3 4h 9 Not st IN LON OG High risk indicators x mother father siblings of baby only w i wW i wW i wiw iwi iN SIHA NI ILIHM Syndromes associated with hearin
6. e f one ear passes and the other ear is lagging make sure the ear coupler is correctly positioned e f baby is lying on that ear pause the screen then turn baby s head so the ear is up adjust the ear coupler and continue screening 24 09 2013 Ta medics Natus ALGO3 NEWBORN HEARING SCREENER TROUBLE SHOOTING HOW TO REDUCE YOUR SCREENING TIMES AND LOWER REFER RATES 1 Choose the right baby well fed calm sleeping 2 Correct placement of the sensors Nape White centre and back of the neck If hard to see better to place down towards the back rather than towards the skull Vertex Black centre of forehead as high as possible Common Green high on front or back of the shoulder 3 Impedance The lower and closer together the impedance numbers are will result in faster screening times and lower refer rates 4 Reduce Myogenic and Ambient Noise 5 Monitor ear couplers Check if the Progress bar is moving if not you need to troubleshoot If there are any of the following 1 High Myogenic 2 High Ambient Noise 3 High Impedance 4 Slow progress Bar Need to Troubleshoot and Intervene One minute of active Intervention can save you several minutes of screening time These Guidelines were developed in conjunction with the user manual and Clinical Practice but do not replace the User Manual or Clinical Judgement 24 09 2013 Appendix 7 Cleaning Algo 3 amp Algo
7. go over any details again for you PASS result from AABR screening Babies with Risk Factors A PASS result today indicates that your baby hears at levels required for normal speech amp language development at the time of the screen your baby can hear you speak Hearing constantly changes throughout our lives and it is important that you monitor these changes This is not a pass for life We recommend that you refer to the hearing amp speech checklist in Your baby s free hearing screen brochure This gives details of the expected responses of your baby up to 18 months of age Your responses to the at risk questions for progressive hearing loss highlight the need for us to continue to monitor your baby s hearing closely Script for generic surveillance appointment You will be offered an appointment around your baby s ae birthday to attend the Audiology Department at the insert Hospital for further assessment This appointment will be posted out to you However if you become concerned regarding your baby s hearing they will accept a referral from your GP at any stage Do you have any questions Can go over any details again for you Script for EARLY surveillance by 6 weeks post screening e g Craniofacial anomalies and Syndromes associated with progressive hearing loss You will be offered an appointment for your baby within 6 weeks to attend the Audiology Department at the i
8. need to clean prep the skin with soap and water some hospitals prefer to use Soap free baby wash This reduces electrical impedance across the baby s skin and allows for better conductivity e f impedance does not initially come down place fingers on sensors and then press gently e If the impedance remains high gt 12kKOhms you may have to prep or reprep the skin Re prep site with NuPrep gel take off sensor place a very small amount of NuPrep ona gauze pad hold skin taught and gently rub the skin remove all the NuPrep with another area of the gauze and replace the sensor Prep area larger then sensor as entire adhesive surface of sensor is conductive If the baby s skin is extremely dry or the sensor becomes dry re hydrate with a drop of N Saline e May need to use a fresh sensor if site has needed to be prepped more than twice this is rare e Make sure the sensors have a low impendence value before screening They should be lt 10 kOhms and stable preferably lower If Impedance is gt 12 kOhms screening cannot proceed You will need to prep or reprep the skin and try amp get lower impedance levels The most sensitive to this is the Vertex forehead sensor e Lower impedances result in faster screening times and fewer false refers e If the impedance is still too high place the sensor clips in the Check Kit You can do this while in screening mode Perform Impedance Check Impedances should go down to 0 kOhms If th
9. s Audiology Hearing Test o Note Audiology contact details in space provided on brochure Remind parents of the possible reasons for the Refer result as listed on the brochure Emphasis the importance of attending for diagnostic assessment Encourage parent s to contact Audiology or Family Support Service if they have any questions prior to appointment Complete the AABR2 Screening results section of the S amp R form o Tick Pass Refer boxes as appropriate for the Right and Left ears o Enter date screener details signature and comments if necessary Complete the Follow up Actions section of the S amp R form o Tick Milestones monitoring amp or otitis media discussed o Record location amp date of referral to Audiology o Tick Audiology Assessment box o Record appointment details if known o Record date of referral to Family Support Service Record the result in the baby s Personal Health Record Book Fax forward a copy of completed S amp R form including Notes page to Audiology Fax a copy of the completed S amp R form including the Notes page to the FSF File the Screening and Referral form in the baby s clinical chart Complete CP documentation if used record notation in mother s amp or baby s charts No result in either ear No result in one ear and Pass result in the other ear No result in one ear and Refer in the other Screen incomplete NA Repeat AABR2 required As a complete screen h
10. should be performed within 1 2 weeks o Screening should be completed by 3 mths corrected age technically babies can be screened up to 6 mths Complete the AABR1 Screening results section of the S amp R form o Tick Pass Refer boxes as appropriate for the Right and Left ears o Enter date screener details signature and comments if necessary Record the result in baby s Personal Health Record Book File the Consent form in the baby s clinical chart File the S amp R form in accordance with local protocol pending AABR2 result Complete CP documentation if used record notation in mother s amp or baby s charts No result in either ear No result in one ear Pass result in other ear No result in one ear Refer in other ear Screen incomplete NA Repeat AABR1 as soon as practical Re screen both ears If a baby is attending as an outpatient the repeat AABR preferably should be done within 1 2 weeks Screening should be completed by 3 mths corrected age although babies can be screened up to 6 mths As a complete screen has not been obtained the AABR 1 Screening Results box should be left blank amp outcome of screen recorded on Notes page of S amp R form o The Screen Incomplete box should only be ticked if the baby has been discharged from HH File the Consent form in the baby s clinical chart File the S amp R form in accordance with local protocol pending a repeat AABR1 result
11. 2013 Review 2015 Standard Letters and Flyers Used by the Healthy Hearing Program Summary and samples of standard letters and flyers used by the Healthy Hearing program Title Parent flyer re missed hearing screen Attach to Your baby s free hearing screen brochure Parent s of baby discharged prior to hearing screen being performed or appointment made Target Group Phone contact usually attempted prior to sending this flyer Purpose Invitation to contact the Healthy Hearing Program to arrange an appointment for a hearing screen THE HEALTHY HENS PROGRAM Somy Nour baby missed haing a heanng Sommer whas in hosptal Vie werd kke fo oer you be opporbuniby tc bring pout baby baci Gor 2 hearing SoS For moe aioe see the rteched brrhauna WHERE insert name of bespaial Hospital WHEN ineen orem days Gor Geers op Ererpday Setercen thar amp 2pm PHONE insert comtarct phone number Fos arranging sOoeenimj appoinment Sorens wal be by appoirimernt oniy Pleas bong pour babys Personal Health Recd Book to Se somone ae eerie berri yr bbr bs aloe HOPE TO SEE YOU SOO Revised August 2013 Review 2015 Possible AABR 2 outcomes continued Result Interpretation Screen Status Follow up actions Documentation Requirements screen Result reversal Refer result is obtained in an ear that gave a Pass result in a previous FLIP FLOP Perform a third sc
12. Appendix 1 Healthy Hearing Glossary of Terms Term Explanation Description AABR 1 The first hearing screen performed where a Refer or Pass result is obtained for both ears AABR 2 The second hearing screen performed following a Refer outcome in one or both ears on the first AABR1 screen where a Refer or Pass result is obtained for both ears Audiological Targeted Babies who receive a Pass result for both ears on their first AABR1 or second AABR2 Surveillance hearing screen but who present with the risk factors for delayed onset or progressive hearing loss listed on the Healthy Hearing Screening amp Referral form require referral to Audiology for comprehensive assessment before they reach 12 months corrected age Corrected age Equals the chronological age in weeks minus time born before 40 weeks Healthy Hearing Screening Is undertaken using an Algo 3 or Algo 3i device using Automated Auditory Brainstem Response AABR technology Brain wave responses are automatically measured and interpreted as a Pass or Refer response Will only detect a hearing loss sufficient to interfere with speech amp language development not whether hearing thresholds are within normal limits Is not diagnostic just identifies individuals who require further assessment Only diagnostic tests audiological amp medical can confirm the presence of a hearing loss Only indicates whether hearing is adequate for the development of
13. Complete CP documentation if used record notation in mother s amp or baby s charts Possible AABR 2 outcomes Result Interpretation Screen Status Follow up actions Documentation Requirements Pass result both ears No High Risk Indicators Bilateral Pass Screening complete No further formal assessment required Parents encouraged to monitor baby s milestones against Speech amp hearing checklist on Healthy Hearing brochure Discuss risk of Otitis Media in the first year due to the higher risk of developing this condition following a Refer result Complete the AABR2 Screening results section of the S amp R form o Tick the Pass box for the Right and Left ears o Enter date screener details signature and comments if necessary Complete the Follow up Actions section of the S amp R form o Tick Milestones monitoring amp or otitis media discussed Record the result in the baby s Personal Health Record Book File the Screening and Referral form in the baby s clinical chart Complete CP documentation if used record notation in mother s amp or baby s charts Pass result in both ears High Risk Indicator s present Early Targeted Surveillance Screening complete Refer to Audiology for follow up assessment within 6 weeks or before baby s 1 birthday Do NOT refer surveillance babies to the FSF Parents are to be encouraged to monitor baby s milestones against Speech amp hearing c
14. ER When a parent declines the HHP screen we are required to record their decision on the HHP consent form document decline in the baby s medical record record the decline on the HHP Screening and Referral form advise them of the proactive language milestone monitoring required by them respect your decision to decline the HHP screen May ask why you are declining Can explain any part of the screening process again for you will make a note of your decline in your baby s medical record Would you please indicate your decline on this form HHP consent form section C in this section here Should you wish to change your mind at a later date we can perform the hearing screen up to 3 months of age We can not offer it after that time period The contact phone number to arrange a screen is will write it here on the brochure Can I show you this section on the brochure point out milestones that lists the normal language milestones your baby should be achieving up to 18 months of age We will be in contact with your family GP to request continued monitoring of your baby s language milestones in partnership with you Revised August 2013 Review 2015 Appendix 5 Hearing Loss Syndrome and condition list for congenital and progressive hearing loss Title A Achondroplasia Albers Schonberg Disease of Osteopetrosis Albinism with blue irides Alport s Syndrome Apert Syndrome Description Hear
15. Health Record Book 1000 1015 Morning Tea Target Surveillance amp Risk Factors e Overview e Case Quiz Algo 3 amp 3i e Screening Characteristics 1015 1230 e Overview of equipment e Technical aspects Screening e Before the screen e Screening e After the screen e Troubleshooting 1230 1300 Lunch Screener Scripts e Why have scripts e Examples 1300 1545 Online Assessment Practical screening demonstration e Application of theory 1545 1600 Afternoon Tea 1600 1630 Discussion amp Evaluation Day 2 inset date PRACTICAL SCREENING Time 0800 1630 Venue insert details Question Time Practical preparation for screening Obtaining consent Completing Screening amp Referral Forms 0830 1000 Practical hearing screening of babies e Skills assessment feedback 1000 1630
16. Hearing Loss Family Support Service Within the next week you will receive information from this team in the mail This service will be able to assist you with any questions and concerns you may have and may be able to help with any difficulties attending the upcoming appointment You will need to attend Audiology Department Level 1 Royal Children s Hospital Herston or Private service provider Please check your appointment letter for details and contact numbers will return with an appointment letter stating the date and time a location map to help you find the Audiology department and parking stations in the area Do you have any questions Can explain the process again for you It is best if your baby sleeps during the audiology testing They recommend that you feed amp settle your baby just before the appointment It may take up to 2 hours and will give them more information about your baby s hearing They will discuss the results with you following the assessment We suggest you have another adult with you to assist with the baby the testing equipment and information gathering at the appointment It is important that you contact Audiology if you are unable to attend your appointment on 3636 7280 or private service provider You can ring and speak to an Audiologist at any time if you require any further information regarding the assessment on 3636 7280 they are very keen to answer your questions DECLINE FROM PARENT CAR
17. ance and the procedures for collecting and recording it appropriate infection control measures when handling babies and using equipment appropriate care in the use cleaning maintenance and storage of equipment an understanding of appropriate actions should data be entered incorrectly consumables applied incorrectly Perform a complete screen without supervision feedback demonstrating o Appropriate baby selection Ensuring an appropriate environment Accurate input of data to Algo Appropriate skin preparation Correct sensor connection and placement Correct ear coupler placement Settling the baby if disturbed during baby preparation 000000 Monitor screen s progress and troubleshoot appropriately Correctly record data in the patient record PHR Book S amp R form Perform an equipment check Reviewed September 2013 HEALTHY HEARING E NEWBORN HEARING SCREENING PROGRAM Hospital QUEENSLAND GOVERNMENT Skills Assessment for Screening with the ALGO 3 3i Newborn Hearing Screener NAME ID Assessor Name ID Tick Applicable Box O Assessment after 2 screens O Assessment after5 screens O Annual assessment Procad Newborn Hearing Screen C Competent eee Skills to be evaluated P hae SetopTen Opportunities provided for parents carer to ask questions Baby selection Baby selected was eligible to screen and in an appropriate state Healthy Hearing Screening amp Referral form completed correctly a Patient dem
18. and relaxed but there may be increased myogenic due to wind bowel movements or other cramps Try repositioning the baby incline the crib especially after feeding if appropriate Babies withdrawing from drugs may be jittery or have internal myogenic which may not be obvious May want to screen baby early day 1 before withdrawal symptoms increase To calm a restless baby Can pat or rub the baby s back Gently place your hands on the baby or gently stroke the baby s head Place baby in mum or dads arms a rocking chair can be very effective Simulate the baby s foetal position by gently cradling one hand over the top of the baby s head and placing the other hand to hold the legs against the tummy All of the above can calm an unsettled baby without producing myogenic Check Environment On a rare occasion there can be interference from another piece of equipment E g Mobile phones fluorescent lights electric beds VCR s May need to turn them off May need to move away from monitors infusion pumps phototherapy lights in immediate vicinity If the baby is quiet and myogenic is still high try another power outlet If there is still too much myogenic go to Equipment check F10 perform Artifact Check this will identify source of myogenic 24 09 2013 If a PASS then you can be sure the myogenic is coming from the baby stop and rescreen the baby at a later time when he she is maybe in a more relaxed state If
19. are occasion there can be interference from another piece of equipment E g Mobile phones fluorescent lights electric beds VCR s may need to turn them off May need to move away from large metal sinks monitors infusion pumps or Phototherapy lights in the immediate vicinity If the baby is quiet and myogenic is still high try moving the device to another area If there is still too much myogenic go to back to main screen Device Setup then Equipment Check perform an Artifact Check it will identify source of myogenic If Algo 3i shows a PASS during the Artifact Check it indicates the myogenic is coming from the baby then stop and rescreen the baby at a later time when he she is in a more relaxed state If FAIL this indicates the myogenic is either coming from the environment or problems with the equipment you may want to try and rescreen elsewhere Ta medics Natus ALGO3 NEWBORN HEARING SCREENER TROUBLE SHOOTING AMBIENT ENVIRONMENTAL NOISE Check Equipment Check ATA transducer cable is properly attached at back of Algo and not damaged Position each ear coupler so cables emerge towards the top of baby s head like horns Check transducers have a secure connection to ear couplers Make sure the ear couplers are sealed around the baby s ear Sometimes if the baby is on his her side the shoulder can push up on the coupler allowing ambient noise to intrude May have to hold
20. as not been obtained AABR2 Screening Results box should be left blank amp outcome of screen recorded on Notes page of S amp R form o Screen Incomplete box should only be ticked if baby s discharged from HH File S amp R form in accordance with local protocol pending a repeat AABR2 result Complete CP documentation if used record notation in mother s amp or baby s charts Possible AABR 2 outcomes continued Result Interpretation Screen Status Follow up actions Documentation Requirements Result reversal Refer result is obtained in an ear that gave a Pass result in a previous screen FLIP FLOP Perform a third screen Reassure parents that the alternating results may reflect fluctuating status within the ear eg fluid or debris amp not an equipment fault Preferably leave 12 24 hours before re screening Screening should be completed by 3 months corrected age although technically babies can be screened up to 6 months Complete the AABR2 Screening results section of the S amp RI form o Tick Pass Refer Not tested boxes as appropriate for each ear o Enter date screener details signature and comments if necessary Record the result in the baby s Personal Health Record Book File the S amp R form in accordance with local protocol pending repeat AABR2 result Complete Clinical Pathways documentation if used or enter notation in mother s amp or baby s charts Revised August
21. ater in life It is therefore important for parents to continue to monitor their baby s hearing understand that if do not give consent for my child to have the hearing screen a hearing loss might not be detected until a later stage Later detection may mean that my child could experience delayed language development C Parent consent or decline I acknowledge that have read or have had explained to me the brochure Your baby s free hearing screen and has explained to me Queensland s Healthy Hearing Program AAAAAAAAAAAA name of hospital staff member e Iwas able to ask questions and raise concerns about the procedure and its risks My questions and concerns have been discussed and answered to my satisfaction I understand that where it is indicated that my child requires further testing health professionals such as my GP Child Health Nurse Paediatrician Audiologist Family Support Facilitator and staff of the Healthy Hearing Program may be notified of the results and may be contacted by staff associated with the Healthy Hearing Program l also understand that The results of the screen will be recorded on a database which assists with follow up of babies who require further testing or treatment The database also allows for monitoring of the Healthy Hearing Program Information from the database may be used for research purposes but names will not be used in any reports or published information If cli
22. bed ___ Possible screening outcomes explained _ _ _ Consent obtained using form amp or interpreter in appropriate language Post screen Disposed of used equipment and completed infection control measures correctly Demonstrated appropriate equipment care amp storage of cables _ Performed Impedance Artifact amp Acoustic checks correctly __ _ _ Housekeeping p ee knowledge of processes for faults monthly checks amp annual ATA Downloaded patient screening data via USB or Infrared mode if applicable Competency O Achieved O Interim reassessment required O Not Achieved Gomments Recommandation 22225050025 Screener Signature E Assessor Signature E Competency Assessment Algo 3 3i Revised 2013 Next review 2015 9 24 2013 Training Format amp Competency Assessment Guidelines for conducting training activities and assessing competencies are listed in the following table Theory Clinical information and A variety of processes can be used Screening Equipment Function and o Lecture l Operation o Demonstration and practice on model o e Learning HELM Question and answer session s Participants perform screens in pairs or as determined by trainer and are observed by trainer o One trainee performs screen and one records data o Feedback should be provided immediately following screen i e not with parent s present unless necessary
23. c facial features atresia of ear canals eyeball retraction Sensorineural Hearing Loss or mixed Winter Syndrome Renal anomalies genital malformation malformed ear and canals Conductive H loss John Muir Medical Centre USA Hearing loss indication list 2000 Patricia Gillilan Audiologist USA Northern and Downs Text Hearing in Children 5th edition 2002 Newton Paediatric Audiological Medicine 2002 References Delene Thomas RBWH Co ordinator HHP Katrina Roberts TTH Co ordinator HHP Reviewed May 2007 Amended March 2012 Kelly Nicholls RCH Audiologist Jackie Moon MMH Audiologist Shree Aithal TTH Audiologist Appendix 6 Troubleshooting Measures Reducing Screening Times amp False Refer Results Screening times can be reduced and false Refer results minimised through Appropriate baby selection Correct baby preparation Active monitoring of the progress of the screen A hearing screen should take between 4 and 7 minutes Although a Refer result may take a little longer it should still take only take 7 to 10 minutes if the baby is well prepared and myogenic and impedance readings are low Baby Selection The key indicator for successful screening is appropriate baby selection For best results babies should be calm quiet settled and recently fed Attempting to screen an unsettled or hungry baby rarely saves time due to longer screening times resulting from Higher myogenic which slows the screen Fr
24. cian field The family should be asked Will this baby identify as being Aboriginal or Torres Strait Islander 3i Details Entered Tick this box when the additional information has been entered The additional data is required to be entered manually Revised August 2013 Review 2015 High Risk Indicators A baby who is identified with a high risk indicator during the screening process is at risk of developing a late onset or progressive hearing loss is referred to Audiology for comprehensive diagnostic assessment before 12 months corrected age If you tick Yes to any one of the risk factors listed the baby must be referred to Audiology on completion of screening for a Target Surveillance assessment before 12 months of age or within 6 weeks on completion of screening for Early Surveillance risk factors Early Surveillance risk factors are indicated by the asterisk The Healthy Hearing Screening and Referral Form is used to initiate the referral to Audiology by fax scanning or copy in the mail A medical practitioner may refer a baby directly for diagnostic audiology The Clinician override medical exclusion box is ticked in the Baby not screened section and the referral sent to Audiology A medical practitioner may refer a baby for Target Surveillance outside of the Healthy Hearing Risk Indicators by utilising the Professional Concern Option All relevant details should be documented on the Screening and Referral form and be pr
25. convulsions Nasal discharge rash anaemia jaundice osteochondritis Bleeding within the brain structures causing adverse neurological complications Cardiovascular disorder fainting sudden death a feature auditory involvement Pigment disorder may include renal disease Craniofacial and skeletal disorder short neck cleft poorly developed inner ear structures Retinitis pigmentosa polydactyly Pigment disorder caf au lait spots cardiac ocular genital growth delay Cardiac condition Short stature skeletal defects cataracts Inner hair cells in cochlear damaged by virus DNA Maternal inheritance pattern Connective tissue disorder facial paralysis Cranial nerves 6 amp 7 middle ear anomalies Onset in teens urticaria renal failure Intracranial tumours 8th Cranial nerve acoustic neuroma See Leopard syndrome caf au lait spots Eye disorder auditory impairment Facial asymmetry anomalies of external middle ear cranial nerve Progressive visual loss polyneuropathy in childhoods Neomycin Amikacin Gentamycin Kanamycin Sisomicin Tobramycin Dibekacin Steptomycin Frusemide loop diuretic used in conjuction with Antibiotics Quinine malarial treatment brittle bones stapes malformation Juvenile skeletal disorder bone pain swelling Ventilation progressive hypoxia persistent fetal circulation Craniofacial anomaly micrognathia glossoptuosis may have cleft palate Periauric
26. d the code for the facility where the baby was born BBA and Homebirths Overseas and interstate births should be entered as OTHER Gestational Age at Birth Other field Record only the whole number of weeks completed on the form For example if gestational age is 38 weeks and 6 days 38 is to be recorded Location of Screen Comments field Tick one of the approved codes The location reflects the current care level of the baby rather than where the screen is being performed Refer to table below for explanation of codes Enter the selected code in the Comment field on the Algo 3 Abbreviations refer to the level of care at the time the hearing screen is being performed CODE INTERPRETATION MAT General Maternity Ward ICN Intensive Care Nursery Intensive Care Unit Neonatal Intensive Care Unit SCN Special Care Nursery BC Birth Centre birth suite birthing department birthing unit labour wards BC encompasses all locations where a baby may birth in a hospital OPD Outpatient at an Outpatient Clinic or completed as an outpatient following discharge PAED Paediatric Ward or Children s Hospital as a transfer or readmission COMM Community residence community health or other settings outside of the hospital OTHER Only entered if none of the other codes are applicable Indigenous Status Number Code Paediatrician field Tick the appropriate code number box Enter the number in the Algo 3 in the Paediatri
27. d the relevant details Note details on the form Enter this information into the Healthy Hearing database as there is no field for this item on the Algo AABR1 Screening Results On completion of the AABR1 document the date time screen outcome and tick the milestones monitoring and or otitis media discussed box and sign in the AABR 1 section A label may be attached if still used in the facility AABR2 Screening Results On completion of AABR2 document the date time screen outcome and tick the milestones monitoring and or otitis media discussed box and sign in the AABR 2 section A label may be attached if used in the facility If the baby receives a Refer result on one or both ears the screener must send a copy of the form via fax to the relevant Audiology service immediately to initiate diagnostic assessment The S amp R form is also to be faxed to the Queensland Hearing Loss Family Support Service Baby not screened or screen incomplete Tick the appropriate box if a baby does not have a AABR1 or screening process is incomplete If a parent declines a hearing screen it is essential to discuss milestones parental monitoring and Otitis Media where the parent s has declined the offer of a hearing screen If the baby has been transferred tick the box record the name of the receiving facility and enter the date that the baby was physically transferred to another hospital Follow up Actions Tick the appropriate box
28. e Heatting Prog Caa a kuater heaghetcdine oepital Ph 07 Chc amp inson phone menhear TAn Pturnston seet pres MEIN farts sad eang serwerrg paplan here Pa wa s da A any 4a mpata te pas baby How mang baters have s hearing bose Je every 1000 bates are bom each year eit s heang ves atch seedi specsisi haig Abad SON of hatews wath a heen bts have ne katan segas of red factors such ot sere Danese oo Nery Pewter of beatens Why screen a baby s tearing a often AOR to et Dut babes Nae d tearing toes Tor ant eatetng Mee betkercur We moe Reve the techetngy D detect 2 hearing tons a the frat tow days of s baby s Me These frst few septs amp morte of a baby 0 fe are very mootan te her te etogerert Tike eeportance of earty kiectilication of hearing lows The sone 2 babys Mesmo toes chentted the comer help can be proveied Aecect reemerch shoes that help a the irsi few mosta of sie tan mabe a difference How is the screening carried out While Pe baby n Geerng natara w om a quet L sete state Oe mre si gently pace wea wal stuhy pads oF babys Mead A sot cicing nose s played Brough earphones ato babys ear The sooty pads oF seson peck wp baby s reiporees i eet The reponse messed by he computer The Sneen u pcd peneste ParentGuactars can stay wih De baby Mroughost the sosen A Pa screener awi you Dee rents amp he ond gi Oe screen your baty o Meer treg ia mot se roomed Contewe t ath your baby a2 ey gow We have mctuded s Hoang amp
29. e a fresh sensor if site has needed to be prepped more than twice this is rare Make sure the sensors have a low impendence value before screening They should be lt 8 kOhms and stable preferably lower If Impedance is reaches 12 kOhms screening cannot proceed You will need to prep or reprep the skin and try amp get lower impedance levels The most sensitive to this is the Vertex forehead sensor Lower impedances result in faster screening times and fewer false refers If the impedance is still too high place the sensor clips in the Check Kit You can do this while in screening mode Perform Impedance Check Impedances should go down to 0 kOhms If they do not amp or fluctuate then there is a problem with the PCA sensor cable and it needs to be replaced Environment Not applicable for impedance problems 24 09 2013 SYY la Medics Natus ALGO3i NEWBORN HEARING SCREENER TROUBLE SHOOTING MYOGENIC Muscular or Electrical Interference Check Equipment Check PCA sensor and Preamp cable are properly connected amp not damaged Check PCA cable not too close to the screener display amp cables are not crossing over each other Ensure A3i display faces away from the baby Check clips are attached only to the purple portion of sensors Check correct clips are attached to sensors Common sensor is not too close to the Nape sensor Check all the sensors are adhering to baby s skin sometime
30. ear coupler gently top and bottom to provide a good seal e Lights flashing in transducers indicate ambient noise Check Baby e Is the baby crying pause screening until baby settles down and ambient noise decreases Check Environment e Check the environment make sure there is not too much environmental noise Eliminate if possible and if not try and find a quieter spot e If the ambient noise bar does not go down and all the trouble shooting has been addressed Go back to main screen Device Setup then Equipment Check and perform an Acoustic Check MONITORING EAR COUPLERS AND FLUCTUATING PROGRESS BAR If the progress bar is constantly fluctuating or does not advance check the following e Arestless agitated baby needs to be calmed down as this will cause the progress bar to fluctuate e Make sure the ear couplers are sealed and close to the baby s head e Make sure the ear couplers are over the ear and not pressing on the outer edges of the ear as this can cause a collapsed ear canal If the baby moves it can reposition the ear coupler it is lying on and cause a closure of the ear canal check this if the progress bar for that ear is lagging Pause the screen lift the ear coupler and gently massage the skin around the opening of the ear tragus to open up the ear canal and displace any debris Gently hold the top and bottom of the ear coupler and then see if the progress bars goes up in another 500 1000 sweeps
31. earing screen is not conducted Sample Parent Letter Missed Appointment Name Address CITY STATE POSTCODE Dear Insert Name understand that you missed your appointment for your baby s free hearing screen Please contact the Healthy Hearing Program at Insert Hospital Name Hospital on 07 Insert phone number to make another appointment If you are unable to attend your new appointment it is important that you contact the Healthy Hearing Program to let them know If you miss 2 appointments without contacting them your baby s name will be taken off the appointment list No further attempts will be made to contact you to arrange another appointment A letter will be sent to your baby s doctor to let them know that your baby has not had the hearing screen If you do not want your baby to have the hearing screen just now but change your mind latter you can contact the Healthy Hearing Program on the above number to arrange a new appointment If your baby does not have a hearing screen it will be very important for you and your family to monitor your baby s hearing If you have any concerns about your baby s hearing you should contact your family doctor Yours sincerely Insert Name Insert Position Title iii oii m mpata hr ww remy habis hove heaeng iem pemeremy 2 amd Based O bomen bee each your heme 9 mere Ken veeh ress mensie neg apat aat ef gata va Id Rae kd Oat ad Maas i wy Mery Bairy Of alo
32. em within a week of referral by mail amp phone Provide parents with Audiology contact details amp encourage them to contact the Audiologist of FSF if they have questions concerns prior to the appointment If a parent declines o Ask if they have a specific reason for declining o Assess if there are is misunderstanding re risks process etc amp clarify o Reinforce implications for i e speech language education if HL remains undetected Ask parent to sign Decline section of the Healthy Hearing Consent form Advise that the baby s GP paediatrician will be notified Offer to screen later should they change their mind Provide Healthy Hearing brochure amp contact details ooo 3 screen required due to result reversal Flip flop Parent s of baby with Refer result on opposite ears on AABR1 amp 2 Explain to parents that o 2nd Refer result is required on the same ear for referral to Audiology o if another Refer result is obtained in either ear then the baby will be referred to Audiology Remind parent s that the Refer result still only indicates that further assessment is required Reassure parents that the result reversal does not indicate an equipment malfunction but can result from fluctuating responses in the ears due to changing fluid levels debris in the ear from the birth process moving positioning of the baby etc Emphasise the importance of attending for the third screen to clarify the situatio
33. equent pausing of the screen to settle the baby Need to re screen due to a Refer result Baby Preparation Time taken to prep the baby s skin and correctly apply sensor tabs and ear couplers will pay dividends in terms of reduced screening times and reduced parental anxiety associated with a false Refer result Refer to the Algo 3 or Algo 3i manual and Scanmedics guides for detailed information on baby preparation and correct application of the sensors and ear couplers Monitoring Progress of the Screen Once a screen is commenced it is important to monitor its progress in order to identify any problems that may develop and to rectify them in a timely manner Important aspects to monitor include Progress bars for each ear Impedance levels Myogenic level Ambient noise levels Troubleshooting will be required if No segments have appeared in the progress bar for either ear by around 2000 to 3000 sweeps Segments in the progress bars remain static for any length of time or keep disappearing Screen is taking more than 10 minutes More in depth troubleshooting will be required if segments in the progress bars have not appeared or progressed by around 7000 sweeps In a situation where the bar is progressing well for one ear but not the other the recommended procedure is to wait for a result from this ear before undertaking troubleshooting for the other ear Once all aspects of troubleshooting have been checked it is then impor
34. es In the situation where your baby can not be screened for a clinical reason a referral to Audiology will be arranged instead this will bypass the screening procedure This is where you need to tick the box do or I do not consent Please sign and date in this section here Section D This is where need to sign and date the form after have explained the screening process to you This section is used if an interpreter is required Are you happy to continue with the screen today Are there any other questions can help you with PASS outcome Well baby no risk factors A PASS result today indicates that your baby hears at levels required for normal speech amp language development at the time of the screen your baby can hear you speak We will not routinely assess your babies hearing again Hearing constantly changes throughout our lives and it is important that you monitor these changes This is not a pass for life We recommend that you refer to the hearing amp speech checklist in Your baby s free hearing screen brochure This gives details of the expected responses of your baby up to 18 months of age If you have any concerns regarding your baby s hearing please contact your GP for a referral to Audiology The Audiology Department located at the Royal Children s Hospital can assess a child s hearing at any age using a variety of age appropriate techniques Do you have any questions Can
35. es to indicate specific action taken If the baby is to return for an outpatient appointment enter the date and time Result reversal is the unusual scenario where one ear has a Pass and the other ear a Refer or N A result in the first screen AABR1 and then the opposite ears Pass and Refer or N A result in the second screen AABR2 A third screen will be required in this situation e Tick the box to show AABR3 is required e Record the results of the AABR3 in the designated AABR3 section on page 2 If an information letter is sent to the baby s GP or other clinician indicate to whom the letter was sent Tick the appropriate reason for the letter and record the date that the letter was sent A copy should be placed in the clinical notes Referral Process If the baby if being referred to Audiology record the name location of the clinic Tick if the reason is for immediate diagnostic assessment or surveillance Record the date that the referral was sent to Audiology Revised August 2013 Review 2015 Record the date and time of the Audiology appointment if known Record the date the referral was sent via fax to the Family Support Service If your facility requires Medical Superintendents signature for referral to Private Audiology tick the Med Super signature for Private Audiology box and arrange for the form to be signed and dated A copy of the S amp R form should be sent to Audiology immediately so the appoin
36. ey do not amp or fluctuate then there is a problem with the PCA sensor cable and it needs to be replaced Environment Not applicable for impedance problems 24 09 2013 1 a 1 Medics Natus ALGO3 NEWBORN HEARING SCREENER TROUBLE SHOOTING MYOGENIC Muscular or Electrical Interference Check Equipment Check PCA sensor and Preamp cable are properly connected amp not damaged Check PCA cable not too close to the screener display amp cables are not crossing over each other Check Algo is plugged into a hospital grade power outlet Check power cord is not coiled when in use Check clips are attached only to the purple portion of sensors Check correct clips are attached to sensors Common sensor is not too close to the Nape sensor Check all the sensors are adhering to baby s skin sometimes the vertex can come loose press down gently and monitor impedance reposition and maybe re prep or use saline to re hydrate the hydrogel Do not place your fingers on the sensors during screening this can cause high myogenic May need to perform Impedance Check to make sure that Myogenic Interference is not due to problems with PCA sensor cable amp Preamp Check Baby Make sure the baby is not due for a feed if so have the baby fed and then screen Reposition head and neck to relax amp ease possible neck tension Wrap the baby securely Be aware of SIDS recommendation The baby may be in a deep sleep
37. family have declined this offer O Diagnostic Audiology appointment declined following Refer result on newborn heating screen This baby recerved a Refer resul on their intial and subsequent hearing screens The famiy was offered a referral to Audiology for diagnostic hearing assessment but they have declined this offer This baby does does not present with specific risk tacton s for the development of a delayed onset or progressive hearing loss o List any risk factoria or delete When you next see thes family would you please advise them of the benefits of the newbom heanng screen and encourage them to contact the Heakhy Hearing Program on the above number to another appointment Should they not wish to proceed with an appointment at this stage wil parteularly important for you and the family to monitor this baby s hearing If there are any concerns about the baby s hearing in the futur the Audiology Departments at Queenstand Health public hospitals wil accept referrals at any age appreciate your assistance with this mater Yours sincerely Insert Name NursefScreener i Revised August 2013 Review 2015 Title Decline information for parents Target Group Parents who decline the hearing screen Purpose Information Invitation for parent s to make contact at a later date We endervtans that you de not sant your beby s hearing screened H you change pour mind st amy time please contect Th
38. for successful completion of screen Practical Screening Initial At least 2 screenings per trainee should be undertaken under these conditions Screener performs screens alone with direct or indirect supervision to be determined by trainer 5 screenings to be successfully performed under these conditions Practical Screening Independent Competencies formally assessed by local area Healthy Hearing Coordinator via o Observation of at least 2 complete screens o Screener can complete HELM assessment online to generate a competency certificate which can be signed off by team leader Feedback Review process with trainer co ordinator Annual mandatory competencies will consist of one practical screening assessment and the completion of the online e Learning module HELM hittp www elearn com au gh_ hearing Sample Training Program Agenda Queensland Government HEALTHY HEARING PROGRAM Universal Newborn Hearing Screening Healthy Hearing Nurse Screener Training Program Day 1 insert date Venue insert Hospital insert e Introductions and Housekeeping 0800 0815 Program Outline for the Healthy Hearing Training Program Introduction amp Protocol e Overview of the Healthy Hearing Program e AABR screening protocol Anatomy of the ear 0815 1000 e How we hear e Types of hearing loss Documentation e Informed consent e Screening and Referral Form e Standard Letters e Personal
39. g informed consent Provide a competent and complete explanation of the screening rationale and process using when offering a hearing screen to parent s including o Benefits of early identification and intervention Description of how the screen is performed Likely duration of the screening process Possible results and their meanings Any follow up actions that might be required oo0 0 Seek informed consent from parents providing an overview of the key contents of the HH Consent form prior to signature Demonstrates appropriate language when communicating with parent s use translated HH resources amp or interpreter if necessary sensitivity to possible concerns of parent s amp provide an opportunity for them to seek clarification in order to minimise parental anxiety collaborative working practices in liaising and problem solving with other members of the maternity team in relation to the hearing screen including data collection timing of screen etc Provide parent s with any other information explanations as necessary before during or after the hearing screen Remind parents at completion of screen what their baby s results mean Ensure parent s have follow up appointments at outpatients or with diagnostic services audiology if required Screening methodology Technical aspects of conducting a screen Demonstrates aclear understanding of the data which must be collected and recorded its signific
40. g loss a WRITE IN THIS BINDING MARG Craniofacial anomalies exclude NIDUVI ONIONIG DO NOT AABR 1 screening results AABR 2 screening results Baby not screened Screen incomplete Follow up actions OPD Screening app t on at Result reversal Flip Flap A Information letter to Referral process Reter to Audiology at Paste and sign label if available Paste and sign label if available WMMAIAM ONY ONINAAMNS ONIN WAH NMOAAAAN Reter to Family Support Facilitator FSF Med Super signature for Private Audiology Page 1 of 2 Guide to Completing the Healthy Hearing Screening and Referral Form S amp R Form The Healthy Hearing Screening amp Referral Form S amp R Form is completed for all live births regardless of whether or not the baby completes the hearing screen This form services several purposes including Collects demographic information Records relevant medical history for example the presence of specified risk factors for delayed onset or progressive hearing loss Template for entering data into the relevant fields on the screen of the Algo 3 or 3i Referral form to Audiology for immediate diagnostic assessment Referral form to Audiology for follow up assessment if specified risk factors identified Referral form to the Queensland Hearing Loss Family Support Service QHLFSS following a Refer result on the second screen AABR2 Documentation record of the hearing screen results and follow up acti
41. gel adhesive which may cause corrosive damage to the clips 9 Make sure you remove any excess cleaning solution with a clean damp cloth and cables are left dry before next use or storage 10 Store cables safely to prevent any damage These Guidelines were developed in conjunction with the User Manual and Clinical Experience Reviewed September 2013 Appendix 8 Screener competency and sample training program Guidelines for Assessing Practical Competencies Specific competencies that must be demonstrated at the completion of training are detailed in the following table Theoretical knowledge amp understanding of evidence for universal newborn hearing screening Demonstrates aclear understanding of basic anatomy amp physiology of the ear abasic understanding of the different types of hearing loss aclear understanding of the impact of a HL on speech amp language development a good understanding of the statewide and local policy in relation to screening protocols and procedures aclear understanding of the circumstances in which a child is listed for follow up or referred and identify the procedures involved Can explain the benefits of early identification of a hearing loss and resulting early intervention and or management the normal developmental milestones for hearing and the importance of monitoring those with all babies Communication with parent s and colleagues offering a hearing screen seekin
42. gnostic Audiology is required Does not indicate that a hearing loss is present though it is important to acknowledge that this is one possibility Is when there have not been 1000 matching responses to the template analysed within the AABR technology and the device has completed at least 15 000 sweeps Screen A procedure applied to a non selected population to identify those who require diagnostic assessment Advantage of screening is the identification of individuals who would not otherwise be suspected of having a problem Screening results are not diagnostic they only indicate the possibility of a condition being present or absent Sweep Cycle where the Algo generates a click amp collects baby s response List of Abbreviations AABR automated auditory brainstem response HLRF hearing loss risk factors ABR auditory brainstem response PCHL permanent childhood hearing loss CP Clinical Pathway PHL permanent hearing loss FSF Family Support Facilitator PHR Personal Health Record Book HH Healthy Hearing QHLFSS Queensland Hearing Loss Family HHP Healthy Hearing Program Support Service HL hearing loss S amp R Form Screening and Referral Form Reviewed September 2013 Appendix 2 Healthy Hearing Forms Below is a summary of the forms used by the Healthy Hearing Program Followed by samples of these forms and guide to completing the Healthy Hearing Screening and Referral Form Translated ve
43. guage seta to Gut of poral hearing chien by 3 years of age Tha has gt Grae eed oF ree Aer soc educeter A segioymert prospects The Paaithy Nearing Progam offers free hearing screens tor af peetom babes Gorn m Quenia kiesiy batem wal have ther hearing scrote drive decharge bom honptal Screereng wi Lew ple weng an Actorated Auditory raem Response AADA atan takes an elechaphymcal measure of the auditory systers response to sound The screw n non ewanwe amp commets of soft Chas beng presented to Pe car vis earphones Sermons record De ewaponse as Pe sour Tawete bomn he ear twoug he audtory Nervous syviern fo he Deas The hearing screen gives a PASS or a REFER tent A PASS reset Gomes Putt a he tne of The saven he baby cout hes at levels aaro for ma speech 6 language develcgrnent As hearing can change gong rontang n recommended wang fe Speech oct Meaung Chechief inctaded on the Sroxtare green to parents at the ime of Pe soemmg If any owo deno regarding fe wys teang they Can be refered to an Audotogey ty Gagnoste msessmeart at any ime A REFER result nanes te peed for fetter sssesomert o deter fa heen ferret a praeri A taty who iiy or ther rda Screen hat s sepest sermen Wf they peeve a second REFER mad fer one or bah aws they ate Pen n b Auaga compreterave hagostx atarsernert Some buos who PASS ther heanng screen are Gentiles m presenting wD epectied m factors tow the Gevetopment of eter onset or progreswye hearg bens These hies we aso reterted 3 Auck
44. hecklist on Healthy Hearing brochure amp to contact Audiology for an earlier appointment if they have any concerns Emphasis importance of attending diagnostic assessment remind them that screen is not diagnostic Encourage parent s to contact Audiology FSF if they have questions prior to appointment Insert reminder slip into baby s PHR Book Complete the AABR1 Screening results section of the S amp R form o Tick Pass Refer boxes as appropriate for the Right and Left ears o Enter date screener details signature and comments if necessary Complete the Follow up Actions section of the S amp R form o Tick Milestones monitoring amp or otitis media discussed o Record location amp date of referral to Audiology o Tick Surveillance box o Record appointment details if known Record result in the baby s PHR Book list the risk factors if not already recorded Fax forward a copy of completed S amp R form including Notes page to the Audiology Fax a copy of completed S amp R form including Notes page to the FSF File the Screening and Referral form in the baby s clinical chart Complete CP documentation if used record notation in mother s amp or baby s charts Refer in both ears Bilateral Refer Refer result in same ear as AABR1 and a Pass result in the other ear Unilateral Refer Immediate diagnostic Audiology assessment required by an approved provider Provide family with a copy of the brochure Your Baby
45. ibe procedure as per brochure o How the screen is done o Potential results o Meaning of a Pass amp a Refer result means o Potential follow up actions AABR2 Audiology Key elements of script all contained in HH brochure Use brochure as a prompt sheet Provide parents with an opportunity to ask questions Arranging an initial Healthy Hearing Screen Parent s familiar with Healthy Hearing Program Remind parent s o How the screen is done o Potential results o Meaning of a Pass amp a Refer result means o Potential follow up actions AABR2 Audiology Key elements of script all contained in HH brochure Use HH brochure as a prompt sheet if necessary Provide parents with an opportunity to ask questions Pass result on the 1 Healthy Hearing Screen Parent s of baby with a Pass result for both ears amp without risk factors Pass result on the 1 Healthy Hearing Screen Parent s of baby with a Pass result for both ears but who has risk factors Refer result on the 1 Healthy Hearing Screen Parent s of baby with a Refer result for one both ears on AABR1 Remind parent s o Pass only indicates baby can hear at a level required for speech amp language development o Pass is not for life ear infections trauma etc o Need for them to monitor of baby s milestones against Hearing amp speech checklist Advise parents to seek Audiology referral if they are concerned about baby s hea
46. ineural Hearing Loss progressive Sensorineural Hearing Loss Sensorineural Hearing Loss Conductive H loss and Sensorineural Hearing Loss Progressive mixed h loss Sensorineural Hearing Loss and Central effects Conductive amp Sensorineural Hearing Loss Conductive or sensorineural Sensorineural Hearing Loss Sensorineural Hearing Loss Sensorineural Hearing Loss Progressive Sensorineural Hearing Loss Progressive Sensorineural Hearing Loss Conductive amp Sensorineural Hearing Loss Conductive H loss Conductive amp Sensorineural Hearing Loss Conductive or Sensorineural Hearing Loss Conductive amp Sensorineural Hearing Loss Sensorineural Hearing Loss Appendix 5 Hearing Loss Syndrome and condition list for congenital and progressive hearing loss Title Description Hearing loss V Mechanical ventilation for longer than 5 days increased neonatal Ventilation risks Sensorineural Hearing Loss Conductive amp Sensorineural Hearing Van der Hoeve s syndrome brittle bone stapes malformation Loss Sensorineural Hearing Loss may be Vohwinkel Nockemann Syndrome See Keratopachyderma reference above progressive Hyperkeratosis of palms soles knees elbows acoustic neuroma Von Reckinghausen s Syndrome renal Sensorineural Hearing Loss WwW White forelock iris colour different in one eye prominent mandible Waardenburg s Syndrome Type 1 amp 2 cleft Sensorineural Hearing Loss Wildervanck s Syndrome Dysmorphi
47. ing loss Conductive amp Sensorineural Hearing Dwarfism skeletal ossification disorder loss Conductive and Sensorineural Hearing Brittle thickened chalky bones Loss Pigmentation disorder eyes skin hair Sensorineural Hearing loss Progressive Sensorineural Hearing Nephritis and cataracts Loss Craniosynostosis midface anomalies middle ear involvement Conductive Hearing loss Aplasias errors during embroyonic development Michel aplasia Mondini aplasia Scheibe aplasia Asphyxia at birth neonatal period Bacterial meningitis Bjornstad Syndrome Branchio Oto Renal syndrome BOR Carraro Syndrome Camurati Engelmann Disease Chemotherapy medications mother and baby Cerebral palsy Craniofacial abnormalities Atresia of the ear canal Absence or malformed pinna Cleft palate CHARGE syndrome Cleidocranial Dysostosis Cockayne s syndrome Cornelia de Lange Syndrome Crouzon s syndrome Dwarfism Down syndrome Encephalitis Engelmann s Syndrome Fanconi s anaemia syndrome Family history of hearing loss Fetal Alcohol Syndrome Fraser Syndrome Friedreich Ataxia Goldenhar s syndrome Hemifacial microsomia Hermann s Syndrome Hyperbilirubinemia Complete absence of inner ear amp auditory nerve Sensorineural hearing loss Abnormal development of the structure turns of the cochlear Sensorineural hearing loss Abnormal formation of the cochlear membrane Sensorineural hearing loss Rescusitation required
48. is repeat screen will be undertaken either in the Hospital prior to discharge or in OPD If you are unable to attend the OPD appointment please contact 36461484 and we will be happy to arrange another appointment for you Do you have any questions Can go over any details again for you PASS following AABR2 screen include otitis media information Refer to appropriate PASS script above ie Pass with without risk factors Include the otitis media evidence from Karen Doyle et al 2004 paper There is some evidence that babies who do not pass their first hearing screen at 48 hours of life but go on to pass their second screen have a higher incidence of an otitis media before their first birthday twice as likely to develop We recommend that you are very vigilant in monitoring your baby s speech and language milestones and seek the review of your family GP when concerns arise REFER AABR2 Diagnostic appointment to be arranged at RCH A REFER result has been obtained on your baby s second screen Repeat the above reasons for a refer outcome ie blockage of external or internal ear possibility ofa hearing loss will arrange an appointment for a more detailed diagnostic test using a similar technique with earphones and sticky pads with the RCH Audiology department This is performed by an Audiologist who is a specialist in the testing of hearing Along with your referral to Audiology we will link you with the QLD
49. l can occur on outcomes of appointments and follow up provided Alternative Contact Details Complete the 2 Alternative Contact Details sections to assist with arranging initial or follow up appointments if the family can not be contacted If possible this should be someone other than the mother s partner Medical Contact Enter name and address of the Family GP Paediatrician or Medical Centre Information can be obtained from the chart in the first instance but should be confirmed with the parent s at the time of the screen A letter will be sent to the family s doctor if the parent s cannot be contacted to arrange an appointment for a hearing screening or if they miss more than 2 scheduled appointments without notification Algo Fields amp Baby s Details The Healthy Hearing Program is required to collect some mandatory data fields and these are entered into the data fields on the Algo 3 and 3i screening devices UR Number Medical Record Number field Record the UR Number of where the hearing screening is being performed f the AABR2 is attended at a different facility to AABR1 record the UR number of where AABR2 is being performed The Healthy Hearing database will link the two different UR numbers when the data is downloaded The baby s current UR Number will also be listed on the baby s ID label on the form Hospital of Birth Birth Location field Refer to the approved list of hospital codes and recor
50. mp Ambient levels are not noise preventing the Algo from detecting the signal too high as this will slow screening down amp prevent the Algo from detecting the signal For detailed guidance on troubleshooting please refer to the Scanmedics flowchart Troubleshooting Measures How to Improve Screening Times amp Reduce the False Refer Rate For other information on baby selection preparation and troubleshooting measures please refer to the Natus Algo 3 3i Newborn Hearing Screener Trouble Shooting and the User Manuals for the Algo 3 amp 3i Suspected Equipment Problems If you suspect a problem with the screening equipment as a result of repeated Refer results for the same ear on different babies or ongoing difficulties reducing Impedance or Myogenic levels Perform the 3 equipment checks as per the equipment manual using the plastic check kit to confirm if the machine if operating correctly Notify your local facility Healthy Hearing coordinator of your concerns Contact the equipment suppliers Scanmedics 02 9882 2088 and or your Area Healthy Hearing Coordinator to discuss you concerns Post Screen Where possible a baby should be left in the same settled state as they were in prior to the screen To minimise any discomfort for the baby when the ear couplers are removed a damp wipe may be used to help release the gel on the ear couplers in order to reduce pulling on the hair and or skin Any baby wash or gel sho
51. n Make arrangements with parent s for AABR2 Healthy Hearing Screener Script Parent Information Introduction Explanation of Screening process to parent carer Hello am onnaa from the Healthy Hearing team would like to offer your baby a free hearing screen Have you had an opportunity to read the brochure will need to obtain your written consent in order to proceed Do you have any questions Can explain the screening process for you e We use a technique called an AAABR Automated Auditory Brainstem Response e Three small sticky gel pads will be gently placed on your baby s head and shoulder area e Earphones are placed over both ears and a series of soft clicking noises are played through these earphones e The sticky pads or sensors will pick up your baby s brain response to these sounds and send it to the machine for analysis e The machine will automatically indicate a PASS or a REFER result e It is a quick screen if your baby is in a quiet settled state It is not painful and most babies sleep through the screen e Do you have any questions Can go over any details again for you The results of the screen e If your baby is settled amp the screen is completed we can tell you the result at the end of the screen e If your baby does not settle we will attempt the screen later in the day e Assoon as the screen is complete and the machine gives an automatic result we will be able to tell you the re
52. n ideal And remember if a baby obtains a Pass in the one ear but becomes unsettled and the screen is discontinued before a result is obtained in the second ear you will need to re screen both ears Troubleshooting Tips Problems encountered during screening may be associated with the Baby Environment Screening Equipment Algo Some questions to ask during a hearing screen if the progress bars are not progressing and or the screening time is prolonged are listed in the following table Question Action Is the sound getting in o Massage the tragus ear canal opening preferably prior to applying the ear couplers o When applying an ear coupler roll it on from back of the ear to the front to prevent it from closing the ear canal o Are earphones placed correctly over the baby s ears and with a good seal o Is the ear canal open o Check if the LED lights are flashing older style cable j o The screener may need to hold the ear coupler s gently top o Are the transducers properly inserted into the and bottom if the ear couplers do not have a good seal ear couplers o Reposition the baby to reduce the risk of the ear canal being pushed closed by the ear coupler s mum s arm etc Is the baby s ABR response getting back to Algo o Check sensors amp cables are properly connected Check cables not cracked or broken O Is myogenic electrical interference or ambient o Check that Myogenic Impedance a
53. n the upper one Place the vertex sensor last of all centre high forehead Check correct placement of sensors White nape Green common Black vertex If impedance gt 12 k ohms make sure that none of the sensors have lifted off the skin Make sure clips are connected to the correct sensor and not loose Check Baby Before screening evaluate baby s skin type as you may need to prep the skin if it is Oily dry amp flaky or has an abundance of hair or lotion on the skin First you may need to clean the skin with soap and water Some hospitals prefer to use Soap free baby wash as this reduces electrical Impedance across the baby s skin and allows for better conductivity If impedance does not initially come down place fingers on sensors and then press gently If the impedance remains high gt 7kOhms you may have to prep or reprep the skin prior to screening If impedances fall between 8 amp 11kKOhms the A3i will display Impedances Marginal message you may begin screening at this point but prepping is recommended Re prep site with NuPrep gel take off sensor place a very small amount of NuPrep ona gauze pad hold skin taught and gently rub the skin remove all the NuPrep with another area of the gauze and replace the sensor Prep area larger then sensor as entire adhesive surface of sensor is conductive If the baby s skin is extremely dry or the sensor becomes dry re hydrate with a drop of N Saline May need to us
54. nary Hypertension of the Newborn PPHN Intraventricular Haemorrhage IVH Periventricular Leukomalacia PVL Record any relevant details Craniofacial Abnormalities Early Surveillance Tick Yes if the baby presents with any craniofacial abnormalities of the head face or neck eg cleft palate Record any relevant details If the only craniofacial abnormality is a cleft lip or skin tags then tick the No box Hyperbilirubinemia Tick Yes only if levels reached or exceeded 450umoll for a term baby or 340 pmol l for a preterm baby Record the maximum SBR level Proven congenital infection Tick Yes if the baby has a history of infection with toxoplasmosis rubella Cytomegaly Virus or herpes confirmed by results of urine and blood analysis of the baby or if the baby is suspected of having syphilis f the mother or baby was suspected of having one of these infections but the baby has since been confirmed as negative then tick No Syphilis may take a series of tests before the result is confirmed If results are not yet available enter U unknown in the Algo and hold the form until the results are available The local Healthy Hearing coordinator will amend the form amp database when the results become available Professional concern other major medical concerns Acclinician may request Target surveillance for reasons that differ from the protocol In this situation tick Yes for Professional Concern and recor
55. nce numbers are will result in faster screening times and lower refer rates 4 Reduce Myogenic and Ambient Noise 5 Monitor ear couplers Check if the progress bar is moving if not you need to troubleshoot If there are any of the following 1 High Myogenic 2 High Ambient Noise 3 High Impedance 4 Slow progress Bar Need to Troubleshoot and Intervene One minute of active Intervention can save you several minutes of screening time These Guidelines were developed in conjunction with the user manual and Clinical Practice but do not replace the User Manual or Clinical Judgement 24 09 2013 Ta medics Natus ALGO3 NEWBORN HEARING SCREENER TROUBLE SHOOTING AND TIPS IMPEDANCE and SENSOR Problems If impedance reading gt 99 kOhms after careful prepping suspect an equipment problem Perform Impedance Check Check Equipment PCA Cable Sensor cable Check Sensor cable is plugged securely into the Preamp Check cables are securely plugged into back of Algo3 and there is no obvious damage Sensors and clips Handle sensors only by the tab or by the edge amp replace on plastic card if re prepping After you have Entered Data press OK then prepare the baby and attach supplies then proceed to screening Place Nape centred back of neck then Common high on front or back of shoulder now check the impedance level Then Place ear couplers first the one the infant is lying on and the
56. ncerns about baby s hearing in the future Pass result on the 2nd Healthy Hearing Screen Parent s of baby with a Pass result for both ears on AABR2 amp without risk factors Remind parent s o Pass only indicates baby can hear at a level required for speech amp language development o Pass is not for life ear infections trauma etc o Need for referral to Audiology for follow up assessment prior to 12 months because of risk factor s for delayed onset progressive hearing loss o Need for them to monitor of baby s milestones against Hearing amp speech checklist Advise parents to seek earlier referral to Audiology if they have any concerns about baby s hearing prior to the scheduled Audiology appointment Hearing Screen Scenario Refer result on the 2nd Healthy Hearing Screen Parent s of baby with a Refer result for one or both ears on AABR1 Parent s decline Healthy Hearing Screen Following standard introduction Purpose Key points to be included Remind parent s o that Refer result only indicates that more detailed assessment by Audiology is required o of possible reasons for a Refer result acknowledging the possibility of a hearing loss as one reason but not the only reason Explain the referral process to Audiology Provide parents with a copy of the brochure Your Baby s Audiology Hearing Test Check that parents are happy to be referred to the Family Support Service who will contact th
57. ne w semne a babys homing ae Ara few esip 5 rmorene wf a babaa He are sery orpartar me De raag be Sibel a baking We Eb Wal Nev Saye ire bo Sra ne ore e eqetiowe of nmty Mteettuaten of taming bna a Derren 3 terwnar poem a a S STOOD Ty OF anga ae Pase io a rasoma mowe a Tets ie veo yont no cmni Sore cent mati an ee E eye CORY NESE veres 19 HR oora A pos have ony coneeren osan your hab s haavaa eaman your darter Revised August 2013 Review 2015 Title GP re baby not screened Tick box options for reason Includes Healthy Hearing Information sheet Includes Hearing amp speech checklist Target Group Nominated GP of babies who do not have a hearing screen commenced completed Purpose To notify GP o that baby s screen has not been commenced completed o advise of the need for ongoing monitoring against the Hearing amp speech checklist o provide contact details for arranging a hearing screen appointment o provide GP with an overview of the hearing screening process for discussion with parents Healthy Hearing Program Information Aceromrrateyy 60000 tutes ae ton com yew n Queerstaed Of pese Gates up to 300 ruy be dom wth a spica eang toss Ths heareg be Qequertly escapes Geiecton unt fe age sten Gaien normaly begn DuA Hewever recent research shows Hwt neonates wih hemmo toon mose wterverdon before amp monte of age Dey car develop speech amp lan
58. nical assessment indicates that my child should not be screened then they will be referred to Audiology for diagnostic assessment On the basis of the above statements Screening consent to my baby having the hearing screen DO NOT consent to my baby having the hearing screen a DO NOT WRITE IN THIS BINDING MARGIN Clinical exclusion to screening consent to my baby being referred to Audiology without screening DO NOT consent to my baby being referred to Audiology without screening Parent name please print Signature Date D Hospital staff statement have explained to the parent the procedure and the risks have given the parent an opportunity to ask questions about any of the above matters and raise any other concerns which have answered as fully as possible am of the opinion that the parent understood the above information 03 2012 Mat No 10188212 v5 00 Staff member name please print Signature Date LNASNOD NWYHY9O d ONIYVAH AHLIVWSH Interpreter cultural needs _ isan Interpreter Service required No have given a translation in _ 5 If yes is a qualified Interpreter present Yes No the consent form and any verbal and written rea Z Is a Cultural Support Person present Yes No given to the parent by the hospital staff member Interpreter name
59. normal speech and language skills at the time of screening Medically suitable Babies who are at least 34 weeks gestational age amp preferably lt than 3 months corrected age amp who have no significant craniofacial abnormalities are in an open crib off ventilators amp are not receiving central nervous system stimulants eg caffeine ototoxic medications or phototherapy for hyperbilirubinaemia Babies can be screen up till 6 months corrected age in some situations Nurse screener Midwife Registered Nurse or Enrolled Nurse who has completed an approved education program and achieved competencies in performing universal newborn hearing screening using the Algo 3 and or 3i AINs are not eligible to be trained to perform hearing screens In some circumstances hearing screening may also be performed by Indigenous Health Workers who have undertaken an approved training program Pass result Only indicates that hearing is adequate at the time of screening for the development of normal speech and language It does not indicate that the baby can hear at normal levels or guarantee that the baby s hearing will not change over time A slight hearing loss could still be present and hearing can change over time so ongoing parental monitoring using the Hearing and Speech Checklist is essential Requires a minimum of 1000 sweeps Refer result Only indicates that further assessment second screen or dia
60. nsert Hospital for further assessment This appointment will be posted out to you However if you become concerned regarding your baby s hearing before this appointment please contact the Audiology department and discuss this matter further Do you have any questions Can go over any details again for you A REFER result on AABR1 A REFER result today indicates that your baby needs another screen There are several reasons why your baby requires a further screen The screen was attempted when the baby was too young Protocol recommends 6 hours or older Baby was unsettled during the screen Excessive background noise during the screen screening conditions or environment were not ideal Baby may have fluid or a temporary blockage in their ear Temporary blockage of the external ear canal due to position of baby s head pressure on the canal residual birth debris in the ear canal residual vernix in the ear canal 6 Possibility of some degree of hearing loss 7 Do you have any questions Can go over any details again for you aRWN gt What happens if the baby refers If the baby refers on either ear we will repeat the screen This may be in hospital or we will arrange for you to return for another screen as an outpatient REFER AABR1 Appointment arranged AABR2 The same technique will be used to assess your baby s hearing The nurse screener will be able to explain the results following the screen Th
61. nst Speech amp hearing checklist on HH brochure amp to contact Audiology for an earlier appointment if they have any concerns Emphasis the importance of attending for diagnostic assessment but remind them that the screen is not diagnostic Encourage parent s to contact Audiology or FSF if they have any questions prior to appointment Provide parent with Your baby s follow up hearing test Complete the AABR1 Screening results section of the S amp R form o Tick Pass Refer boxes as appropriate for the Right and Left ears o Enter date screener details signature and comments if necessary Complete the Follow up Actions section of the Healthy Hearing S amp R form o Tick Milestones monitoring amp or otitis media discussed o Record location amp date of referral to Audiology o Tick Surveillance box o Record appointment details if known Record the result in the baby s PHR Book amp list the risk factors Fax forward a copy of completed S amp R form including Notes page to Audiology File the Screening and Referral form in the baby s clinical chart Complete CP documentation if used record notation in mother s amp or baby s charts Refer result both ears Bilateral Refer Refer result in one ear Pass result in other ear Unilateral Refer AABR2 required o Rescreen as soon as possible but ideally leave a minimum of 12 to 24 hours between screens o If a baby is attending as an outpatient the AABR 2
62. ocessed by the Healthy Hearing Team Should a clinician have concerns regarding a baby s hearing thresholds prior to a scheduled appointment a referral will need to be initiated outside of the Healthy Hearing Newborn Screening Program by the treating clinician Record any relevant details Use the Notes page if more space is required Family history of permanent childhood hearing loss mother father siblings of baby only excluding grommets ear infection trauma This does not include hearing loss due to injury childhood ear infections and the insertion of grommets in the eardrum tympanic membrane Clarification can be sought from Paediatrician or Audiologist when uncertain if a reported hearing loss meets the required definition Questions that you can ask to confirm whether the hearing loss was a permanent childhood hearing loss include e Was the hearing loss associated with ear infections e Was the hearing loss associated with an injury or accident e Did the hearing loss occur before the family member reached school age e Was the hearing loss permanent or did hearing improve over time e Does did the family member wear a hearing aid s e Does the family member have any trouble with their speech Syndromes associated with hearing loss Early Surveillance There are more than 400 syndromes associated with hearing loss Some of the more common ones include the following Refer to Appendix 6 Syndromes Associated with a Hearing Lo
63. ographics f Data collection Hearing loss high risk indicators identified Information obtained from medical record Clarification with parent as required Correct patient data information entered into Algo3 3i _Confirmed that baby was in a quiet settled state before proceeding Skin evaluated and prepared correctly Sensors placed correctly Procedure Ear couplers applied correctly Progress of screen observed and monitored Ensured minimal ambient noise impedance and myogenic levels Progress bars monitored _ Troubleshooting and intervention undertaken as required Screen outcome result explained to parents Ongoing language milestone monitoring and Otitis Media risk discussed Parents carer encouraged to ask questions and further information provided as required Appropriate follow up process action undertaken as required AABR2 arrangements Referral for diagnostic Audiology appointment within 2 to 6 week time frame Referral to Family Support Service when ABR appointment required Referral for Surveillance Audiology scenarios o Early Target Surveillance by 6wks o Routine Surveillance prior to 1st birthday Written record documentation process completed Communicated as appropriate with other care providers eg Clear and accurate information given to parents carer Brochure in appropriate language provided amp or interpreter used Reason aim of screening program explained Screen offer Procedure descri
64. oiogy for Gagnosic Besen somenmne gor to few first brai AD healt Care practer can ppor the healthy beaeng Program by asago parents b attend Pew Neary saper and aucdctogy apportiments Anning parerts b mosir ther ch f hearing Amming farses to come amp im wih a dapas of few bhos 6 mimg Agr ptet ater necessary 1 you weed the tthe pirmaa atm Re Meaty teary regan vet De Healthy erg wetete at hop www O contact your xa Healy eang Progam Name Organeaton if relevant Address CITY STATE POSTCODE Dear Insert Name Re Insert baby s name Baby of Insert Mother s Name Insert baby s date of birth Gonder inson Maib or Female Insert street number amp name Insert suburb State Postcode Issue a Missed initial newborn hearing screen appointment This baby was decharged before a heanng screen could be complated Efforts to arrange for the baby to return to the hospital for a heanng screen have proved unsuccessful a Missed follow up newborn hearing screen appointment following Refer result on initial screen This baby received a Refer result in their initial hearing screen Efforts to arrange for the baby to return to the hospital for a follow up heanng screen have proved unsuccessful The second hearing screen it necessary to determine d diagnose assessment by an Audiologist is requred Refer result Chck amp enter the ear s with refer result car s I Newborn hearing screen declined This baby was offered a heanng screen but the
65. ons The Baby s Details and High Risk Indicators are completed by referring to the medical charts maternal and neonatal rather than by asking the mother or family The chart provides a more reliable source of information protects patient confidentiality The exception is when collecting information on Family history of permanent childhood hearing loss This will usually require discussion with the parent s or the family as this aspect of medical history is often not well documented in the medical record Where a baby dies or is transferred for medical reasons before the hearing screen process is commenced high risk indicators can be left blank If a baby s family declines the screen or fails to attend scheduled screening appointment s then all sections of the form except screening results are to be completed and filed in the baby s chart Revised August 2013 Review 2015 The Additional Notes section on the reverse side of the form can be used to record any additional information regarding the hearing screen history Baby s amp Mother s Details Affix the Baby s Patient Identification Label and the Mother s Identification Label in the designated boxes on the form Alternatively the details can be hand written on the form if no stickers are available Facility Service Enter the name of your hospital This information is important if a referral is made to Audiology or QHLFSS correspondence to the referring hospita
66. reen Reassure parents that the alternating results may reflect fluctuating status within the ear eg fluid or debris amp not an equipment fault Preferably leave 12 24 hours before re screening Screening should be completed by 3 months corrected age although technically babies can be screened up to 6 months Complete the AABR2 Screening results section of the S amp RI form o Tick Pass Refer Not tested boxes as appropriate for each ear o Enter date screener details signature and comments if necessary Record the result in the baby s Personal Health Record Book File the S amp R form in accordance with local protocol pending repeat AABR2 result Complete Clinical Pathways documentation if used or enter notation in mother s amp or baby s charts Revised August 2013 Review 2015 Title Parent letter re missed appointment Including Hearing amp speech checklist Target Group Parent s who have failed to attend for their baby s screening appointment Phone contact usually attempted at least twice prior to sending this letter Purpose Invitation to contact the Healthy Hearing Program to arrange another appointment for hearing screen Advice that baby will be taken off appointment list if parent s do not make contact Invitation for parent s to make contact at a later date Advice re the need to monitor baby s hearing against the Hearing amp speech checklist if the h
67. ring in the future Remind parent s o Pass only indicates baby can hear at a level required for speech amp language development o Pass is not for life ear infections trauma etc o Need for referral to Audiology for follow up assessment prior to 12 months because of risk factor s for delayed onset progressive hearing loss o Need for them to monitor of baby s milestones against Hearing amp speech checklist Advise parents to seek earlier referral to Audiology if they have any concerns about baby s hearing prior to the scheduled Audiology appointment Remind parent s that Refer result only indicates that further assessment is required Explain the range of reasons for a Refer result acknowledging a hearing loss as one possibility Emphasise the importance of attending for the second screen to clarify the situation Make arrangements with parent s for AABR2 Pass result on the 2nd Healthy Hearing Screen Parent s of baby with a Pass result for both ears on AABR2 amp without risk factors Remind parent s o Pass only indicates baby can hear at a level required for speech amp language development o Pass is not for life ear infections trauma etc o Advise parent s of potential increased risk of otitis media glue ear due to Refer result on AABR1 o Need for parents to monitor of baby s milestones against Hearing amp speech checklist Advise parents to seek referral to Audiology if they have any co
68. rsions of the Consent Form in various languages is available on the Healthy Hearing Website for printing at http Awww health qld gov au healthyhearing pages trnsltdcnsnt as Title Target Group Purpose Healthy Hearing Parent s of all babies who give Medico legal document for recording Program Consent Form consent or decline the hearing o Parent s understanding of the hearing screen amp any screen risks associated with having not having screen o possible use of the results including recording in the data base research amp notification to other health professionals o parent s consent decline of hearing screen 3 3 Queensland Affix identification label here a ca Government URN 3 9 Healthy Hearing Program Family name 3 Consent Given name s 5 S Address f Facility Date of birth Sex M F 3 2 A The hearing screen Affix identification label here understand that all newborn babies should have a URN amp hearing screen to check if the baby might have g a hearing problem Family name 3 Given name s 3 isks 3 B Are there any risks AdAS understand that there are no known risks of injury to a baby in this procedure but Date of birth There is a small chance that the hearing screen may show that there is no hearing loss where there might in fact be a hearing loss A child could still develop a hearing loss l
69. s medical record Revised August 2013 Review 2015 Appendix 3 Summary of Potential Result Combinations Follow up Actions amp Documentation Possible AABR 1 outcomes Result Interpretation Screen Status Follow up actions Documentation Requirements Pass result in both ears No High Risk Indicators Bilateral Pass Screening complete No further formal assessment required Parents encouraged to monitor baby s milestones against Speech amp hearing checklist on HH brochure Complete the AABR1 Screening results section of the S amp R form o Tick the Pass box for the Right and Left ears o Enter date screener details signature and comments if necessary Complete the Follow up Actions section of the Healthy Hearing S amp R form o Tick Milestones monitoring amp or otitis media discussed Record the result in baby s Personal Health Record Book File the Consent form in the baby s clinical chart File the Screening and Referral form in the baby s clinical chart Complete Clinical Pathways CP documentation if used or record notation in mother s amp or baby s charts Pass result in both ears High Risk Indicator s present Early Targeted Surveillance Screening complete Refer to Audiology for follow up assessment within 6 weeks or before baby s 1t birthday Do NOT refer surveillance babies to the FSF Parents are to be encouraged to monitor baby s milestones agai
70. s conductive Skeletal anomalies shortness short fingers Sensorineural Hearing Loss Conductive SN or mixed hearing Middle ear anomalies ossicles otitis media infections losses Sudden permanent Sensorineural Infection Auditory involvement Hearing Loss Bone dysplasia increased skeletal density affecting auditory function Impaired renal transport growth delay Sensorineural Hearing Loss Permanent hearing loss evident in early infancy lt 6 years see QH S amp R list Conductive or sensorineural Conductive and Sensorineural Hearing LBW skeletal anomalies cleft palate pinnae anomalies Loss Conductive and Sensorineural Hearing Adherent eyelids external ear malformations syndactyly Loss Progressive ataxia cataracts Sensorineural Hearing Loss Conductive H loss or Sensorineural Eye ear and mouth anomalies Hearing Loss Abnormal development on one side of the face atresia stenosis Conductive H loss or Sensorineural canal Hearing Loss Late onset of disease Epilepsy speech ataxia renal disease Sensorineural Hearing Loss Sensorineural Hearing Loss may have Dampening of the Auditory nerve function due to excessive bilirubin aud neuropathy Appendix 5 Hearing Loss Syndrome and condition list for congenital and progressive hearing loss De Title Hypoxic Ischaemic Encephalopathy HIE Hydrocephalus Hunter s and Hurler s Syndrome Infections Cytomegalovirus Herpes Rubella Toxoplasmosis Syphillis Intraventric
71. s the vertex can come loose press down gently and monitor impedance reposition and maybe re prep or use saline to re hydrate the hydrogel Do not place your fingers on the sensors during screening this can cause high myogenic May need to perform Impedance Check to make sure that Myogenic Interference is not due to problems with PCA sensor cable amp Preamp Check Baby Make sure the baby is not due for a feed if so have the baby fed and then screen Reposition head and neck to relax amp ease possible neck tension Wrap the baby securely Be aware of SIDS recommendation The baby may be in a deep sleep and relaxed but there may be increased myogenic due to wind bowel movements or other cramps Try repositioning the baby incline the crib especially after feeding if appropriate Babies withdrawing from drugs may be jittery or have internal myogenic which may not be obvious May want to screen baby early day 1 before withdrawal symptoms increase To calm a restless baby Can pat or rub the baby s back Gently place your hands on the baby or gently stroke the baby s head Place baby in mum or dads arms a rocking chair can be very effective Simulate the baby s foetal position by gently cradling one hand over the top of the baby s head and placing the other hand to hold the legs against the tummy All of the above can calm an unsettled baby without producing myogenic Check Environment 24 09 2013 On a r
72. ss in the Healthy Hearing Program Protocols and Guidelines for a more detailed list 2 Brachio otorenal 2 Foetal Alcohol Syndrome 2 Stickler 2 Charge association 2 Goldenhar 2 Treacher Collins a Chromosomal abnormality eg 2 Klipper Feil a Usher Down Syndrome 2 Noonan s a Waardenburg Trisomy 13 18 a Nager Turner s Syndrome a Osteogenesis Imperfecta Tick Yes if the baby has been diagnosed with any one of these syndromes or if they are suspected of having one of these syndromes If a baby has been diagnosed with a syndrome other than those listed above and you are unsure if it is associated with progressive or delayed onset hearing loss check with the baby s doctor paediatrician Prolonged ventilation for more than 120 hours with IPPV CPAP HHFNCT Tick Yes if the baby was ventilated for 120 hours or more with Intermittent Positive Pressure Ventilation IPPV Continuous Positive Airway Pressure CPAP or Humidified High Flow Nasal Cannula Therapy HHFNCT Record the number of hours Bacterial Meningitis confirmed or suspected Tick Yes if the baby has a confirmed history of bacterial meningitis or is suspected of having had bacterial meningitis Record any relevant details Severe asphyxia at birth Revised August 2013 Review 2015 Tick Yes if the baby has a history of severe asphyxia at birth resulting in a sequelae characterised by convulsions Hypoxic Ischaemic Encephalopathy HIE or Persistent Pulmo
73. sult What does PASS REFER mean A PASS result indicates that your baby hears at levels required for normal speech amp language development at the time of the screen Your baby can hear you speak A REFER result means we will need to repeat the hearing screen again Obtaining consent would like to explain the consent form to you Have you had an opportunity to look over the brochure describing the screening process Do you have any questions about the brochure information Section A This section recommends all babies should have their hearing checked Section B This part outlines there are no known risks of injury to your baby during the screen There is a small chance of a false result from this screening process 1 in a million It is important for you to continue to monitor your baby s hearing even after the screen today This outlines that a delay in detecting a hearing loss could delay your baby s language development Section C This is where sign screening staff member after have explained the screening process for you encourage you to raise any questions or concerns at this stage Should your baby require further hearing tests your consent on this form will allow us to share the screening information with other health professionals The screening results will be stored on our database All information is confidential and no names are used when reports are generated for program evaluation and research purpos
74. tant to allow the Algo to continue and complete the screen without further interference If baby selection and preparation guidelines have been followed and appropriate troubleshooting measures undertaken the outcome will be a valid result regardless of whether it is a Pass or Refer A screen should only be discontinued prior to a result being obtained for both ears if The baby has become agitated and attempts to settle them have failed tis realized that the equipment is not attached to the baby correctly or is faulty eg cracked broken loose cable ear coupler dislodged Consumables have been applied incorrectly eg ear transducers reversed A screen should never be discontinued because The segments on the progress bar s are not progressing or keep disappearing despite thorough troubleshooting The progress bars suggest that the baby is about to receive a Pass result for both ears The progress bars suggest that the baby is about to receive a Refer result for 1 or both ears Reasons for continuing a screen for longer than 20 minutes would need careful consideration However it is important to assess each situation individually and for the nurse conducting the screen to use their judgment For example if the baby is older and more alert and or the opportunity to perform a screen at another time is unlikely then it may be worth persevering with the screen despite it taking longer than recommended and or conditions being less tha
75. tment process is not delayed Page 2 reverse side of the form Baby s amp Mother s Details Affix patient identification labels if using page 2 This is important in case the form is copied or faxed to another provider at any time AABR3 Screening Results If the baby does require AABR3 following a result reversal flip flop document the screen result A label may be attached if still used in the facility in the additional note section If a baby obtains a Pass result on the AABR3 then milestones parental monitoring and Otitis Media should be discussed reinforced with the parent s Tick the box when this task has been completed If the baby receives a Refer result on one or both ears the screener must send a copy of the form via fax or mail to the relevant Audiology service immediately to initiate diagnostic assessment The screening and referral form is also to be faxed to the Queensland Hearing Loss Family Support Service Additional Notes For some babies additional notes may need to be made regarding the screening process Use the Additional Notes section for this purpose Failure to attend appointments Attempts to contact parent s to arrange appointments Advice sought by medical practitioners audiologists or others regarding high risk indicators etc AABR3 screening result can be completed on this page Any extra Notes pages should be filed with the original Healthy Hearing Screening and Referral Form in the baby
76. ular haemorrhage IVH Jervell and Lange Nielsen syndrome Keratopachyderma and digital Constrictions Nephrosis Klippel Feil syndrome Laurence Moon Biedl Bardet Syndromes LEOPARD Syndrome Multiple lentigines syndrome Long QT Syndrome Marshall Syndrome Meningitis Mitochondrial disorders Moeibus Mobius Syndrome Muckle Wells Syndrome Neurofibromatosis type II Noonan s Syndrome Norries Syndrome Oculo Auriculo Vertebralia Spectrum OAV Optic atrophy and polyneuropathy Ototoxic Medication affecting inner ear hair cells Osteogenesis imperfecta Paget s disease Persistent Pulmonary Hypertension of the Newborn PPHN Pierre Robin Syndrome Periauricular abnormalities Periventricular leucomalacia PVL Piebaldness Pendred s Syndrome Pyle s Syndrome Refsum s Syndrome Richards Rundle Syndrome Stickler syndrome Treacher Collins syndrome Trisomy 21 Down syndrome Trisomy 13 15 amp 18 Turner s Syndrome Usher Syndrome Description Severe aphyxia with neurological sequalae hypotonic limbs significant morbidity IVH Grade 3 amp 4 internal cranial anomalies 8th Cranial Nerve involvement Progressive manifestation of coarse facial features Herpes virus 5 microcephaly hepatosplenomegaly jaundice IUGR Congenital neonatal herpes infection HSV 1 amp 2 High mortality LBW purpura jaundice Organ of Corti degeneration Parasitic infection chorioretinitis cerebral calcification
77. ular pits tags fistulas ear canal atresia facial paralysis Ischaemic cystic changes in the brain matter predisposing to Cerebral palsy Lack of pigment in hair ataxia blue irides Thyroid goiter iodine imbalance in inner hair cells Enlargement and sclerosis of the facial bones ribs clavicles Organ of Corti degeneration inner ear anomalies eye disorder CNS disorder ataxia muscle wastings Flattened facial profile cleft palate ocular changes Head and neck anomalies atresia of canal abnormal middle ear Recurrent Middle ear infections High mortality rate Gonadal dysgenesis webbed neck amp digits micrognathia Retinitis pigmentosa tunnel vision vertigo organ of Corti degeneration Hearing loss Sensorineural Hearing Loss may have aud neuropathy Sensorineural Hearing Loss Mixed Hearing loss Sensorineural Hearing Loss Sensorineural Hearing Loss Sensorineural Hearing Loss Sensorineural Hearing Loss Sensorineural Hearing Loss Sensorineural Hearing Loss and Central effects Sensorineural Hearing Loss Sensorineural Hearing Loss Conductive and Sensorineural Hearing Loss Sensorineural Hearing Loss Sensorineural Hearing Loss Sensorineural Hearing Loss Sensorineural Hearing Loss Conductive and Sensorineural Hearing Loss Sensorineural Hearing Loss Sensorineural Hearing Loss Sensorineural Hearing Loss Sensorineural Hearing Loss Sensorineural Hearing Loss and Central effects Sensor
78. uld be wiped off the baby s skin on completion of the screen Reviewed August 2013 io medics NATUS ALGO3 NEWBORN HEARING SCREENER TROUBLE SHOOTING GUIDE IMPEDANCE and SENSOR Problems If impedance reading gt 99 kOhms after careful prepping suspect an equipment problem Perform Impedance Check Check Equipment PCA Cable Sensor cable e Check Sensor cable is plugged securely into the Preamp e Check cables are securely plugged into back of Algo3 and there is no obvious damage Sensors and clips e Place the sensors on the baby when you get to Baby Preparation Screen This allows you to monitor the impedance while preparing the baby e Handle sensors only by the tab or by the edge amp replace on plastic card if re prepping Place Nape centred back of neck then Common high on front or back of shoulder Now check the impedance level Then Place ear couplers first the one the infant is lying on and then the upper one Place the vertex sensor last of all centre high forehead e Check correct placement of sensors White nape Green common Black vertex e If impedance gt 12 k ohms make sure that none of the sensors have lifted off the skin e Make sure clips are connected to the correct sensor and not loose Check Baby e Before screening evaluate baby s skin type as you may need to prep the skin if it is Oily dry amp flaky or has an abundance of hair or lotion on the skin First you may
79. use the progress bar to fluctuate e Make sure the ear couplers are sealed and close to the baby s head e Make sure the ear couplers are over the ear and not pressing on the outer edges of the ear as this can cause a collapsed ear canal If the baby moves it can reposition the ear coupler it is lying on and cause a closure of the ear canal check this if the progress bar for that ear is lagging Pause the screen lift the ear coupler and gently massage the skin around the opening of the ear tragus to open up the ear canal and displace any debris Gently hold the top and bottom of the ear coupler and then see if the progress bars goes up in another 500 1000 sweeps e f one ear passes and the other ear is lagging make sure the ear coupler is correctly positioned e f baby is lying on that ear pause the screen then turn baby s head so the ear is up adjust the ear coupler and continue screening 24 09 2013 3 io medics Natus ALGO3 NEWBORN HEARING SCREENER TROUBLE SHOOTING HOW TO REDUCE YOUR SCREENING TIMES AND LOWER REFER RATES 1 Choose the right baby well fed calm sleeping 2 Correct placement of the sensors Nape White centre and back of the neck If hard to see better to place down towards the back rather than towards the skull Vertex Black centre of forehead as high as possible Common Green high on front or back of the shoulder 3 Impedance The lower and closer together the impeda

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