Common Errors and Potential Harms

Common documentation errors

NSO frequently notes the following errors:

• Missing critical data fields
  • For example, missing date/time of collection, date of birth, or date/time of blood transfusion.
  • Please ensure all fields on the card are completed prior to sending the sample to NSO.
• Entering in the incorrect date of collection when a sample is collected close to midnight.
  • Please use extra caution when completing the date of collection if the sample is collected close to midnight.
• Entering the mother’s health card number into the infant’s health card number field.
  • If the infant does not have a health card number, please leave this field blank.
• Utilizing expired blood cards.
  • Prior to obtaining the sample, please check that the blood spot collection card is not expired.

Potential harms of inadequate documentation

The potential adverse impact of missing and/or inaccurate demographic information on the interpretation of an infant’s specimen can have very serious consequences.

• Inaccurate provision of the date of birth and/or collection can lead to an infant screening negative for conditions on the panel when truly affected (false negatives), or screening positive when they are not truly affected (false positives). Both scenarios place unnecessary burden on the infant, their family and the health care system.
• Failure to indicate that an infant has had a transfusion could lead to an infant screening negative for a subset of disorders on the panel when they are truly affected.
• Failure to provide an accurate birth weight and/or feeding status can lead to difficulty interpreting results and ultimately delays in identifying a truly affected infant.
• Inaccurate completion of the parent/guardian’s information and/or primary health care provider’s contact information can lead to delays in locating an infant who has screened positive – and subsequent delays in the initiation of treatment.
• Inaccurate demographic information on the infant (e.g. incorrect Ontario Health Card Number) can lead to infant misidentification and/or prevent our database from linking multiple specimens on the same infant together.

Many submitters in Ontario have instituted a “quality control check” where each newborn screening card is reviewed by the charge nurse, unit clerk or laboratory staff to ensure it has been fully completed prior to being sent to NSO.