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Screening: Antenatal screening for Heamoglobinopathies Clinical Guideline

V1.0

October 2018

Screening: Antenatal screening for Heamoglobinopathies v1.0

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1. Aim/Purpose of this Guideline

This document provides guidance for midwives to enable them to offer informed choices to

all pregnant women regarding participation in the linked sickle cell and thalassaemia

screening programme and to provide guidance in the event of a couple being identified as

higher risk by screening.

2. The Guidance

2.1 About the NHS sickle cell and thalassaemia screening programme

This programme is a linked antenatal and newborn programme - neither component should be viewed in isolation. Women and their partners [the baby’s’ biological father] are offered screening for sickle cell and thalassaemia antenatally. All new-borns are offered screening for sickle cell as part of the newborn bloodspot programme

2.2 Aims of the Guideline and Screening Programme

To offer all pregnant women screening for sickle cell and thalassaemia by 10+0 weeks of pregnancy

If the pregnant woman is identified as, or known to be a carrier - offer screening to the baby’s father as soon as possible so that the identification of those couples at risk of having a baby with a major haemoglobinopathy can be offered early prenatal diagnosis [PND] by 12+0 weeks

To perform PND by 12+6 days

To ensure all babies are offered screening for sickle cell disease as part of the newborn bloodspot screening programme in order to allow early diagnosis and to improve outcomes through early treatment and care

2.3 Background

Haemoglobinopathies are a group of disorders in which there is an abnormal haemoglobin molecule. Sickle cell and thalassaemia are autosomal recessive conditions of the blood. Inheritance of an altered gene variant from both parents results in a seriously affected baby, and inheritance of only one altered gene variant results in a minimally affected carrier. Sickle originated in West Africa and the thalassaemia’s [alpha and beta] extend from the Mediterranean to the Far East. They are most commonly found in people whose ethnicity is derived from these areas but migration over many centuries has resulted in dispersion of these genes throughout the world.


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2.4 Screening Approach The Family Origin Questionnaire [FOQ], together with the initial screening Full Blood Count [FBC] is used to assess risk and determine further testing. Accurate and complete information in the FOQ is essential. There are two approaches to the offer of screening depending on whether a Trust is defined as either high prevalence (HP) or low prevalence (LP) High prevalence trusts are those where sickle cell diseases are estimated to affect over 1.5 pregnancies per 10,000 births. Information from the FOQ is used to interpret the blood results Low prevalence trusts are those where sickle cell diseases are estimated to affect less than 1.5 pregnancies per 10,000 births. The FOQ is used to screen women and the baby’s father and assess the risk of haemoglobin variants and sickle cell disease

RCHT is defined as a low prevalence Trust

2.5 Key Messages for screening in low prevalence areas:

Screening involves the combined use of the Full Blood Count sample and the Family Origin Questionnaire

Thalassaemia screening takes place in the haematology lab using the FBC sample to check certain red blood cell indices

Sickle Cell screening is initiated by the haematology lab according to the FOQ. If the woman or the father of the baby is from a high risk group, screening is performed on the FBC sample using the electrophoresis.

Low risk women will not be automatically tested for Sickle Cell but the red cell indices may identify a Thalassaemia trait

The FOQ (Appendix 3) is used in the lab as the basis of determining which women to test for the haemoglobin variants and helps in the interpretation of laboratory results. Therefore careful attention to the complete provision of accurate information of the FOQ is important

2.6 Antenatal screening processes for sickle cell and thalassaemia at RCHT

2.6.1 Pre-booking

Prior to booking the woman will be given the booklet: ‘Screening tests

for you and your Baby’ Translations are available in 11 languages

and can be accessed from:

https://www.gov.uk/government/publications/screening-tests-for-you-

https://www.gov.uk/government/publications/screening-tests-for-you-and-your-baby-description-in-brief


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and-your-baby-description-in-brief

2.6.2 Booking timings

Women should be offered the screening test by 10+0 weeks of

pregnancy; however, women who present later in pregnancy should

still be offered screening

This early booking appointment allows the opportunity for the father

of the baby to be tested, allowing prenatal diagnosis [PND] to be

offered by 12+0 weeks and completed by 12+6 weeks.

If prenatal diagnosis is required, couples should be given results

within 5 working days of the result being available

2.6.3 Information giving

In order for the woman to make an informed choice, the midwife should

discuss the following points:

The benefits of screening for herself and her baby and the management of a

screen positive result including referral to a haemoglobinopathy specialist and

obstetrician.

That low risk women will not automatically be tested for sickle cell but the

routine analysis of the full blood count sample [FBC] may identify them as a

possible thalassaemia carrier [see FOQ].

The results procedure, including the feedback of the results and the possibility

of a false negative or false positive result.

The role of the Family Origin Questionnaire, which should be completed by

the midwife with the woman, ticking the relevant boxes should ensure that at

least three generations are considered

The basic principles of recessive inheritance of sickle cell and thalassaemia.

More information can be found at sct.screening.nhs.uk

2.6.4 Testing women in subsequent pregnancies

The most recent recommendations issued in the National SCT Screening

Laboratory Handbook 2017

[https://www.gov.uk/government/publications/sickle-cell-and-thalassaemia-

screening-handbook-for-laboratories] is to offer testing in every pregnancy,

even if women have been found to have a variant or thalassaemia previously.

We follow this policy at RCHT.

2.6.5 Testing the baby’s father if he has been tested previously

If the baby’s father has been tested for sickle cell and thalassaemia

previously, the same protocol should be used as for a previously tested

mother. We follow the ‘Test every time’ policy at RCHT.

2.6.6 Situations requiring particular care: Fertility Treatment

https://www.gov.uk/government/publications/screening-tests-for-you-and-your-baby-description-in-brief


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If the pregnancy has been achieved by the use of a donor egg then the screening results on the woman will not be informative so the baby’s father should always be tested to ensure that this is not a high risk pregnancy.

Careful completion of the FOQ section H will initiate father of the baby testing by the laboratory in liaison with the screening coordinators.

If donor sperm has been used then it may be appropriate to refer back to the fertility clinic if the screening results on the woman show that she is a carrier for a haemoglobinopathy.

The haematology laboratory will advise in these circumstances.

If a pregnancy has been achieved by donor egg and donor sperm then the fertility clinic should be contacted to ascertain whether the donors were screened before donation. It is useful for the lab to have this information although it is understood if this is not always possible.

The haematology laboratory will advise in these circumstances.

2.6.7 Taking the blood

If the offer of screening for haemoglobinopathy is accepted, the laboratory

should be sent a single lavender tube [FBC] specimen to arrive to the lab within

one working day.

In order to identify the specimen as an antenatal screening sample, the blood

bottle should be labeled as per Trust standards and put into a clear specimen

bag with the white copy of a fully completed FOQ.

The requestor’s signature should be clear and legible.

The gestation at the time of the blood MUST be documented on the FOQ

The middle [pink] copy of the FOQ should go in the maternal hand held notes

The bottom [yellow] copy of the FOQ should go in the hospital case notes

2.6.8 If the laboratory receives incomplete information on FOQ or FBC:

The lab will contact the Screening Coordinators by email requesting that the

named midwife with responsibility for the woman [or a midwife with

responsibility for the woman if the named midwife is absent] is contacted to

request a new FOQ to be sent or that the midwife contacts the haematology

lab on ex 2502 with the information they require.

The screening coordinators will continue to check their failsafe system weekly

to ensure a result is available.

Similarly, if the lab receives a FOQ without an adequate FBC sample, they

will contact the screening coordinators to request a new sample is drawn. The

Screening Coordinators will then contact the appropriate midwife by email

initially and then by phone to ensure samples are sent in a timely manner.


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2.6.9 Documentation

The midwife should document the following in the in the woman’ hand held

notes:

The date the screening was offered

Whether haemoglobinopathy screening was accepted or declined

The date the sample was taken

The result and date it was given

2.6.10 If Screening is Declined:

The top copy of the FOQ should be sent to the laboratory with the declined

box ticked and the reason for the decline given if possible. The middle copy of

the FOQ should be placed in the maternal hand held notes and the bottom

copy added to the case notes.

Explain that the blood sample taken for FBC antenatal assessment may

reveal abnormalities on the red cell indices which may lead to a request for

further testing for SCT.

If the woman declines further testing despite an identified abnormality in the

red cell indices, write ‘HPLC declined’ on FBC form, send to lab and

document in hand held notes and hospital records.

If screening is declined it should be noted in the hand-held notes and

recorded on the maternity IT/E3 system.

2.6.11 Results

The laboratory will report the results of the specimen in accordance with

national guidance and enter them onto the Pathology system.

The responsible midwife will review the results within the pathology system

within 10 days of the bloods being taken.

The results should be entered onto the maternity E3 system

If the result shows no evidence of thalassaemia or abnormal haemoglobin, the

result should be reported to the woman at her next antenatal visit (usually 16

weeks) by the community midwife and documented in the hand held notes.

In the event of a positive result, two scenarios are possible;

1. The woman is a carrier of a haemoglobinopathy

2. The woman has a haemoglobinopathy

Father of the baby testing will be initiated in both cases

2.6.12 If maternal results show a carrier status:


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The laboratory will provide interpretation of the results and the requirement for

any onward testing. The laboratory will contact the screening coordinators and

the following pathway will be initiated:

The screening coordinator will contact the woman and inform her of her

healthy carrier status

If father of the baby testing is required, the screening coordinator will contact

the woman to offer counselling and testing within 3 days of the available

maternal result

The screening coordinator will document the discussion and outcomes on the

maternity E3 system and in the woman’s handheld notes.

When the blood sample is obtained the coordinators must ensure that the father of the baby test specimen can be linked with the maternal sample. This is done by ensuring both parents details are on the form (Maternal CR number and maternal name) and informing the laboratory when the sample is taken so that they can expect it. A yellow alert sticker should be applied to the blood form and the lab phoned to inform them that the sample is on its way.

Ideally, this should be completed by 12+0 weeks of pregnancy.

The screening coordinators will check for the result daily.

2.6.13 If the father of the baby test result is negative:

The screening coordinator will inform him of his result initially by phone and then in writing within 2 weeks of the result. The results will then be recorded in the hospital case notes, on the maternity E3 system and relayed in writing to the community midwife and GP, for documenting in the maternal hand-held notes with partner consent.

The screening coordinators will send an Alert Form to Bristol Newborn Blood Spot lab to inform them of the results and provide the linkage into the postnatal Newborn Blood Spot screening programme.

2.6.14 If the father of the baby is a carrier of a haemoglobinopathy or

is affected with a haemoglobinopathy:

The Screening Coordinators will inform the father of the baby of his

status by telephone. Urgent appointments will be arranged by the screening

coordinators for specialist counselling for the woman and her partner.

At this appointment the offer of prenatal diagnosis will be made depending on

the ancestral origins from the FOQ. The offer of prenatal diagnosis, whether

accepted or declined, should be recorded in the handheld and hospital

records.

Ideally this should be completed by 12+6 weeks of pregnancy.

Additionally, father of the baby status is documented in the handheld and

hospital records, Maternity E3 system with partner consent. Also, it should be


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noted under ‘Special considerations’ of the postnatal page so that it can be

recorded on the new-born bloodspot card for the baby by community midwife.

2.6.15 If the father of the baby is unavailable for testing (and mother is a

carrier or affected by haemoglobinopathy):

An urgent appointment should be arranged for the woman with the Screening

Coordinators/Fetal Medicine Consultant to determine whether prenatal

diagnosis should be offered in view of ancestral origins of the father of the baby

and information provided on the FOQ.

The offer of prenatal diagnosis, whether accepted or declined, should be

recorded in the handheld and hospital records. Additionally, the father of the

baby status should be documented in the handheld and hospital records.

Additionally, it should be noted under ‘Special considerations of the postnatal

page so that it can be recorded on new-born bloodspot card for the baby.

The Screening Coordinators will send an Alert Form to Bristol New-born Blood

Spot lab to inform them of the results and provide the linkage into the New-

born Blood Spot screening programme

2.6.16 If a woman has full haemoglobinopathy:

The Screening Coordinators will inform the woman of her status and arrange

urgent joint maternal medicine/haematology appointment.

A plan of care must be documented in the maternal handheld and hospital

records. Additionally, the mother’s status will be documented in the hospital

records and on the maternity IT system by the Screening Coordinators. The

result should also be noted under ‘Special considerations’ of the postnatal

page so that it can be recorded on new-born bloodspot card for the baby by

community midwife.

Where a woman fails to attend an appointment for a high risk result, the

Screening Coordinator will contact the woman and ensure that she has all the

information required to make a fully informed decision about her on-going care.

This will be documented on E3 and in the woman’s hand held notes and

hospital notes.

Father of the baby testing will be initiated and results and procedures followed

according to the circumstances as outlined above.

2.7 Alpha Thalassaemia

Alpha thalassaemia varies in severity.

People with Alpha Thalassaemia + do not usually have any problems, though may be slightly anaemic. The children of women who have Alpha Thalassemia + are


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not usually at risk of a severe disorder.

People with Alpha Thalassaemia 0 [most often of Far Eastern ethnicity] are more affected [with anaemia] and children of those with Alpha Thalassaemia 0 are at risk of a severe disorder [death in utero or Hydrops Foetalis is possible].

Alpha thalassemia [unlike Beta] cannot be diagnosed on haemoglobin

electrophoresis [the test which is used after a FBC to confirm both sickle cell and

beta thalassemia]. The screening FBC result in people with Alpha thalassaemia trait

looks very similar to that in people with iron deficiency anaemia. Therefore, Alpha

Thalassemia trait is assumed to be present ONLY when iron deficiency has been

excluded.

Therefore if a woman has a report identifying ‘possible alpha + thalassaemia

carrier and/or iron deficiency’

1. Investigate a possible anaemia by requesting a ferritin level. If iron deficiency is

identified, review with GP and treat as appropriate.

2. Re-test for haemoglobinopathy status at completion of iron therapy in conjunction

with laboratory advice

If a woman has a report identifying a ‘possible alpha thalassaemia zero and/or

iron deficiency’

1. Investigate a possible anaemia by requesting an urgent ferritin level. If a

deficiency is identified, review with GP and treat as appropriate

2. The Laboratory will liaise with screening coordinators to initiate father of the baby

testing as appropriate

3. Re-test for haemoglobinopathy status at completion of iron therapy in conjunction

with laboratory advice

2.7.1 Pre natal diagnosis

Where prenatal diagnostic is offered it should be undertaken in a timely manner with the aim of CVS being undertaken following appropriate counselling regarding the benefits and risks of an invasive procedure. This will usually be undertaken by the Screening Coordinator and Fetal Medicine Consultant, in liaison with the haematology team.

2.7.2 Linked Programme Alert

Where the mother or the father of the baby is identified as a haemoglobinopathy carrier, the Screening Coordinator will inform the new-born blood spot laboratory in Bristol in the antenatal period via an Alert Form. Details will also be entered onto the Maternity Screening Tracker

2.7.3 Postnatal newborn results

Where an affected new-born is identified through new-born bloodspot screening, the lab will contact the Screening Coordinator who will review the parental result. If any inappropriate/missing actions in the antenatal period are identified a datix must be completed and the incident investigated as per Trust and National Screening Committee process.


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2.8 ROLES AND RESPONSIBILITIES

2.8.1 Antenatal screening coordinator (ANSCO)

Monitor failsafe and contact community midwifery (CMW) staff where there are concerns relating to antenatal screening for haemoglobinopathies including follow up of missing or incomplete FOQ’s

Inform CMW if screened woman has a result requiring further action as detailed in this guidance

Receive any results requiring further investigation, via the generic screening e-mail account

Contact the woman and arrange for further testing/father of the baby testing, within 3 working days

Track the results where repeat or father of the baby samples have been requested

Arrange for counselling of affected couples and commence high risk pathway

Complete New-born alert proforma and send to Newborn screening lab as per instructions on form

Provide annual updates for midwives on all ante natal and newborn screening

Monitor and complete quarterly key performance indicators (KPI)

Complete the annual report including SCT

Monitoring/audit of screening programmes annually 2.8.2 Midwives responsiblity

Comply with this and all current associated guidance

relating to sickle cell and thalassaemia screening

Ensure the woman receives the leaflet ‘screening tests

for you and your baby’ in advance of her booking

appointment

Ensure the information is available in a format to suit the

needs of the woman, e.g. if English is not the first language

or the woman has a disability

At the booking appointment ensure a discussion takes place with the

woman and her partner about the reasons for testing and gain consent for

testing

Complete the Family Origin Questionnaire (FOQ). If the woman

declines testing the FOQ should still be completed and sent to the lab

Ensures a fit for purpose sample arrives in the haematology

department and obtain a result within 7-10 days

Ensure the woman is aware of the test result

Ensure any positive results are managed in accordance with this guidance with involvement of the local antenatal screening coordinator

Report any adverse events using the Trust Datix system


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2.8.3 Laboratory

Appropriate accreditation with a nationally approved scheme e.g. United Kingdom Accreditation Services (UKAS)

Ensure a senior staff member at consultant level (medical or clinical scientist) is responsible for the haemoglobinopathy screening service with defined levels of accountability

Ensure the adoption of the national testing algorithm

Ensure the adoption of the guidelines for standard of reporting screening results

Ensure there is a standard operating procedure for the antenatal sickle cell and thalassaemia programme from receipt of the specimen until the dispatching of the report.

Ensure the provision of a report or interim report within 3 working days of receipt of specimen in the laboratory

Participation in local or national audit relating to the screening programme.

Willing to release of information on screening performance to national screening Committee and its representatives There must be a documented risk management policy for laboratory aspects of Haemoglobinopathy screening

Laboratory must participate in External Quality assurance scheme, Sensitivity of testing protocol >95% detection of carriers/ affected individuals

Failsafe policy and arrangements in laboratory and Maternity services for acting on and reviewing positive screening results. Laboratory to work with Maternity Unit to ensure a joint review of positive results on a regular basis. Participate in regular audit meeting to review accountability and responsibility and screen positive results

Referral of specimens risk assessed for all aspects of the process (responsibility, transfer, receipt of results in a timely manner and reporting) Reports received from third parties/referral laboratories are transcribed into the internal laboratory information systems in a full and exact copy of the report


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3. Monitoring compliance and effectiveness

Element to be monitored

Key performance indicators (KPI) for antenatal screening to include:

Sickle cell and Thalasseamia screening

Lead Screening Coordinators Jenny Stevenson and Jeanne Clarkson

Tool National KPI tool

ST1 identifies coverage: that SCT screening is offered to the eligible population and each woman accepting screening has a screening result available at the day of the report

ST2 identifies the proportion of women having antenatal SCT screening for whom a result is available by 10+0 days gestation

ST4 measures the timely offer of prenatal diagnosis (PND) to women at risk of having an affected infant. The risk associated with ‘at risk women’ and ‘at risk couples’ is different therefore this KPI is in 2 parts:

1. At risk women offered PND by 12 weeks and 0 days gestation (ST4a).

2. At risk couples offered PND by 12 weeks and 0 days gestation (ST4b).

Frequency Quarterly KPI reporting Annual Report

Reporting arrangements

Bi- annual Screening Programme Board and regional screening team

Acting on recommendations and Lead(s)

Screening Coordinator and Screening Programme Board

Change in practice and lessons to be shared

As per action plan

4. Equality and Diversity 4.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the 'Equality, Diversity & Human Rights Policy' or the Equality and Diversity website.

4.2. Equality Impact Assessment

The Initial Equality Impact Assessment Screening Form is at Appendix 2.

http://www.rcht.nhs.uk/GET/d10268876

http://www.rcht.nhs.uk/GET/d10268876

http://www.rcht.nhs.uk/RoyalCornwallHospitalsTrust/OurOrganisation/EqualityAndDiversity/HumanRightsEqualityAndInclusion.aspx


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Appendix 1. Governance Information

Document Title


Date Issued/Approved: 10th August 2018

Date Valid From: 10th October 2018

Date Valid To: 10th October 2021

Directorate / Department responsible (author/owner):

Antenatal and Newborn Screening: Jenny Stevenson, Jeanne Clarkson

Contact details: 01872 253092

Brief summary of contents To give local guidance on the screening programme for sickle cell/thalassaemia in pregnancy

Suggested Keywords: SCT, sickle cell, thalassaemia, haemoglobinopathy

Target Audience RCHT CPFT KCCG

Executive Director responsible for Policy:

Medical Director

Date revised: August 2018

This document replaces (exact title of previous version):

Sickle Cell and Thalassaemia (SCT) Screening Clinical Guideline V1.0. This is part of a separation of one large guideline so is a new ‘standalone’ guideline and is therefore v1.0

Approval route (names of committees)/consultation:

Maternity Guidelines Group Obstetrics and Gynaecology Directorate Policy Review Group Divisional Board

Divisional Manager confirming approval processes

Tunde Adewopo

Name and Post Title of additional signatories

Not Required

Name and Signature of Divisional/Directorate Governance

{Original Copy Signed}


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Lead confirming approval by specialty and divisional management meetings Name: Caroline Amukusana

Signature of Executive Director giving approval

{Original Copy Signed}

Publication Location (refer to Policy on Policies – Approvals and Ratification):

Internet & Intranet Intranet Only

Document Library Folder/Sub Folder Clinical/Midwifery and Obstetrics

Links to key external standards Governance Team can advise

Related Documents:

References: NHS Screening Programmes (2017): Sickle Cell and Thalassaemia. Handbook for laboratories UK National Screening Committee (2017) Key Performance Indicators UK National Screening Committee (2017) NHS Sickle cell and Thalassaemia Screening programme: Failsafe processes.

UK NSC (2017) NHS Sickle Cell and Thalassaemia Screening Programme: Standards for the linked Antenatal and Newborn Screening Programme. 3rd edition

Training Need Identified? NO


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Version Control Table

Date Version

No Summary of Changes

Changes Made by (Name and Job Title)

01 Dec 15 V1.0 Initial Issue Maggie Denholm

10 Aug 18 V1.0

Streamlined national guidance Updated Alpha Thalassaemia recommendations. Taken from the initial issue as above but is v1.0 of a new stand alone Guideline.

Jenny Stevenson Screening Coordinator

All or part of this document can be released under the Freedom of Information Act 2000

This document is to be retained for 10 years from the date of expiry.

This document is only valid on the day of printing

Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy for the Development and Management of Knowledge, Procedural and Web

Documents (The Policy on Policies). It should not be altered in any way without the express permission of the author or their Line Manager.


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Appendix 2. Initial Equality Impact Assessment Form

This assessment will need to be completed in stages to allow for adequate consultation with the relevant groups.

Name of Name of the strategy / policy /proposal / service function to be assessed


Directorate and service area: Obs & Gynae Directorate

Is this a new or existing Policy? Existing

Name of individual completing assessment: Jenny Stevenson/Jeanne Clarkson

Telephone: 01872 253092

1. Policy Aim*

Who is the strategy / policy / proposal /

service function aimed at?

To give guidance to midwives on how and why to offer screening for sickle cell and thalassaemia to our eligible population of pregnant women and to create a link into the postnatal newborn blood spot screening programme

2. Policy Objectives*

To ensure women are offered screening for sickle cell and thalassaemia in accordance with National Screening Committee guidance

3. Policy – intended Outcomes*

To ensure all women are appropriately offered screening in each pregnancy for sickle cell and thalassaemia and women/couples who are identified at higher risk are entered into care in a timely manner

4. *How will you measure the

outcome?

Compliance Monitoring Tool

5. Who is intended to benefit from the

policy?

All pregnant women in our cohort

6a Who did you consult with b). Please identify the groups who have been consulted about this procedure.

Workforce Patients Local groups

External organisations

Other

X

Please record specific names of groups Maternity Guidelines Group Obstetrics and Gynaecology Directorate Policy Review Group Divisional Board


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Are there concerns that the policy could have differential impact on: Equality Strands: Yes No Unsure Rationale for Assessment / Existing Evidence

Age X

Sex (male,

female, trans-gender / gender reassignment)

X

Race / Ethnic communities /groups

X

Disability - Learning disability, physical impairment, sensory impairment, mental health conditions and some long term health conditions.

X

Religion / other beliefs

X

Marriage and Civil partnership

X

Pregnancy and maternity

X

Sexual Orientation, Bisexual, Gay, heterosexual, Lesbian

X

You will need to continue to a full Equality Impact Assessment if the following have been highlighted:

You have ticked “Yes” in any column above and

No consultation or evidence of there being consultation- this excludes any policies which have

been identified as not requiring consultation. or

Major this relates to service redesign or development

What was the outcome of the consultation?

Guideline agreed

7. The Impact Please complete the following table. If you are unsure/don’t know if there is a negative impact you need to repeat the consultation step.


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8. Please indicate if a full equality analysis is recommended. Yes No X

9. If you are not recommending a Full Impact assessment please explain why.

No areas indicated

Signature of policy developer / lead manager / director

Jeanne Clarkson

Date of completion and submission 10th August 2018

Names and signatures of members carrying out the Screening Assessment

1. Jeanne Clarkson

2. Human Rights, Equality & Inclusion Lead

Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD This EIA will not be uploaded to the Trust website without the signature of the Human Rights, Equality & Inclusion Lead. A summary of the results will be published on the Trust’s web site. Signed Sarah Jane Pedler Date 10th August 2018


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Appendix 3.


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Appendix 4

TRAINING

Staff Group / s

Division /

Department

Frequency of

training / update

Method of training

delivery

Lead and department responsible for provision

of training

All midwives involved in screening

Women and Children’s

Annual Maternity Update Day

ANSCO and Practice development midwife

ANSCO Women and Children’s and Pathology

Once on Induction

Pegasus Heads of Service area

Biomedical scientists

Haematology lab Annual Cascade of update in formation for SOP

Heads of service area

Clinical Scientific Leads

Haematology lab As required Attend regional/national update meeting on scheme

Heads of service area