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Quality standards

The purpose of the National Policy and Quality Standards is to document the operational policy and quality standards of practice for providers of services within the Universal Newborn Hearing Screening and Early Intervention Programme (UNHSEIP).

These standards form part of the contract between the Ministry of Health and DHBs for the provision of UNHSEIP services. The National Policy and Quality Standards were first published  in June 2013 and updated (2nd edition) July 2016.

Diagnostic and amplification protocols

This document is an evidence-based protocol which combines audiological research, clinical expertise and patient values and circumstances. This document details key procedural elements and technical specifications required for the provision of audiologic assessment and amplification to babies and pre-school children. These babies and children have been identified through the Universal Newborn Hearing Screening and Early Intervention Programme (UNHSEIP) or have been referred to Audiology due to incidental or discovered risk for permanent hearing loss.

This document was updated in October 2023 and replaces previous versions. It is acknowledged that although this document provides an evidence-based protocol to inform best clinical practice at the time of publication, the technology and evidence base are continually evolving. Clinicians should continue to exercise professional judgement and clinical decision making that reflects the individual circumstances with the goal of placing whānau at the centre of the clinical decision-making process.

Procedures and practices

The Universal Newborn Hearing and Early Intervention Programme (UNHSEIP) carries out a two stage regime, using aABR technology with the BERAphone equipment, to screen for hearing loss. This is introduced below.

Automated Auditory Brainstem Response (aABR)

This screen measures the integrity of the inner ear and also the auditory pathway. It therefore is able to measure the brain’s response to sound and identify children with the rare condition of auditory neuropathy where the cochlea is normal but the child has hearing loss.

This screen, usually takes about 10-20 minutes once baby is settled and is also painless for baby. If there is no clear response from the first screen (aABR1) then a second screen (aABR2) is performed. If there is still no clear response then baby will be referred to audiology for diagnostic testing.

Recommendations

The NSU recommends that the parents and guardians of all babies born in New Zealand are offered newborn hearing screening for their babies.

The NSU recommends that the parents and guardians of all babies born in New Zealand are offered newborn hearing screening for their babies.

Reports into quality improvements for the UNHSEIP programme

The reports below relate to a range of improvements to the newborn hearing screening programme.

 

In July 2012 a screening incident was identified where some babies were not screened according to the screening protocol.

 

An investigation into the incident led to the quality improvement review below. That review outlined 21 recommendations to further strengthen the programme and its monitoring.

 

The reports below outline the progress made in implementing the review’s recommendations – including an independent review into the screening test or regime.

Audit programme

Monitoring of screening programmes is required to ensure ongoing quality and an evidence base to service development.

An audit programme is an important component of continuous quality improvement of screening programmes.

In 2012, the Ministry of Health contracted Deloitte through an open tender process to lead and co-ordinate a three year audit programme for the UNHSEIP reviewing activities in all districts.

The first round of audits commenced in May 2012 and will be completed by June 2014.

Summary of DHB service audit programme to September 2013 (PDF, 107KB)

 

Monitoring reports

Monitoring Reports are produced by the National Screening Unit, based on screening and audiology information provided by UNHSEIP providers – the district health boards (DHBs). The UNHSEIP Advisory Group reviews the draft Monitoring Reports, and makes recommendations.

 

The draft Reports, with recommendations, are then sent to DHBs for their comment, corrections on matter of fact, and for them to respond to any specific recommendations.  Responses to recommendations are published alongside the finalised Monitoring Reports.

Monitoring Framework

This framework outlines the indicators for monitoring the performance of the Universal Newborn Hearing Screening Programme (UNHSEIP).

 

The monitoring framework is a plan for the routine, systematic collection and recording of information about aspects of the programme over time and covers the entire pathway from newborn screening to audiology assessment to early medical and education intervention services. The 2009 framework is centred around the UNHSEIP ‘1-3-6’ goals and was updated in 2015 to align with the change in the screening protocols to automated auditory brainstem response (aABR) screening only.

 

Regular monitoring against standard indicators helps to assess whether programme aims and objectives are being met and informs continuous quality improvement of all components of the programme pathway.

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