For over 50 years, there has been widespread acceptance of the need to identify hearing loss at an early age. Until just recently, however, very few hospitals were operating universal newborn hearing screening programs. Since 1993, hundreds of hospitals have implemented such programs. Based on the experiences and using materials from many of these pioneering hospitals, the following checklist was developed. This checklist includes the steps that typically must be addressed in implementing and operating a successful early identification of hearing loss program for newborns.

The 13 points included in this checklist will help you benefit from the experience of others as you design a universal newborn hearing screening program for your hospital. In completing the checklist, though, you should remember that each hospital and situation is unique, and the timing or the specific way in which the various activities are accomplished may have to be modified. Based on the hundreds of hospitals that are now operating successful universal newborn hearing screening programs, most, if not all, of the activities described in the checklist will have to be addressed. Remember that successful newborn hearing screening programs almost always involve a "team approach" with many stakeholders (e.g., audiologists, physicians, nurses, parents, etc.) being collaboratively involved. Additional information and concrete suggestions about how to address each item in the checklist is available in the rest of this web site or by contacting NCHAM.

UNHS Implementation Checklist

Point 1. Enlisting Support for Newborn Hearing Screening

• Support from authoritative groups.
• Many other hospitals are doing it successfully.
• Has newborn hearing screening become the standard of care?
• Physician support is essential.
• It won't happen without support from the nursing staff.

Point 2. Determining an Appropriate Protocol for Your Hospital

• Which equipment is best for your situation?
• Wouldn't it be better to wait for the next generation of screening equipment?
• How many tests should be included in the screening protocol?

Point 3. Dealing with Procedural Issues

• Who's in charge?
• Who will do the screening?
• When should screening be done?
• Making sure every baby is screened.
• Should screening be done with the parents present?
• Should parents be asked to sign a permission form?

Point 4. Communicating with Parents, Physicians, and Hospital Staff

• Communicating with parents: What, when, and how?
• Communicating with physicians.
  • General awareness of the program and its importance.
  • What were the results for their parents?
• Ensure that the physicians understand the importance of follow up.
  • Medical management issues.
• Communicating with hospital administrators.
• Justifying ongoing program support.

Point 5. Training Newborn Hearing Screeners

• Initial Training.
• Don't train more people than necessary.
• Regular supervision.
• Retraining to accommodate staff turnover.

Point 6. Keeping Referral Rates Low

• Schedule screening when babies are in the best behavioral state.
• Make a second effort prior to discharge to screen babies who do not pass at first.
• Minimize noise and confusion in the screening area.
• Use the best protocol for your situation.
• Have backup equipment and supplies readily available.
• For OAE procedures, probe fit is critical.
• For AABR procedures, screen when myogenic activity is low.

Point 7. Managing Data and patient Information

• Computer-based data management.
• Should you try to design your own system?
• Can you modify one of the databases your hospital already has?
• Safeguarding your data.

Point 8. Financing the Program

• How much does it really cost?
• Will insurance pay for newborn hearing screening?
• Is newborn hearing screening cost beneficial?
• How do I convince the insurance companies to pay?
• Does Medicaid pay for newborn hearing screening?
• Using existing state resources.
• Grants, donations, and community support.

Point 9. Caring for Equipment and Supplies

• An ounce of prevention is worth a pound of cure.
• Don't assume people know how to take care of computers.
• Most hospitals provide computer support­ask for it.

Point 10. Reporting

• Generating regular reports for program management and improvement.
• Don't expect to find a lot of babies with hearing loss.
• Make people aware of your successes.

Point 11. Completing Audiological Diagnosis and Follow Up

• A good screening program is not enough!
• Involve experienced audiologists.
• Use appropriate diagnostic procedures for infants and toddlers.
• Move as quickly as possible.
• Monitoring of amplification.

Point 12. Coordinating with State Systems

• Timely, appropriate, family-centered intervention is the real goal.
• Coordinate with early intervention programs.
• Don't wait to start screening until the diagnostic and intervention system is perfected.
• Coordination with other public health information databases.

Point 13. Considering Legislative Mandates

• Is legislation a good idea?
• Don't wait to start until you have a legislative mandate.
• What legislative activities are happening in other states?