Republic of the Philippines

ISABELA STATE UNIVERSITY

City of Ilagan Campus
COLLEGE OF NURSING

NEWBORN SCREENING CHECKLIST

Name: ___________________ Date: ______________

Year & Section: ___________ Score: _____________
PROCEDURES REMARKS
1. Explain the procedure / educate the parents
2. Prepare all the materials use for NBS – filter card, non-powdered
gloves, 70% isopropyl alcohol, dry and wet cotton balls, sterile
lancet, micropore tape and drying rack
3. Fill out a newborn screening card with the infant’s vital
information—name, sex, weight, and date and time of birth—and
the date and time of the blood collection.
4. Do hand washing, wear non-powdered gloves Non powdered gloves
use so as not to
contaminate the blood
5. Position the infant Head is higher than the
lower extremities
6. Warm, massage or used clean cloth soak with warm water and Check the infant’s heel
carefully sterilized the infant’s heel
7. Used wet cotton with alcohol to sterilized the heal and dry the
area
8. Make a small puncture in the baby’s heel and squeeze out a few
drops of blood.
9. Put the absorbent part of the card in contact with the blood drop. Part of the card
consists of special
absorbent paper used
to collect the blood
sample.
10. Continue until all the printed circles on the card contain a blood
sample
11. Place the filter card in drying rack and let it dry for about 4 hours
12. Clean your area and throw all sharps in sharp box
13. Document the patient’s information.
14. The card is then sent to a laboratory, where the blood is tested
for the various conditions as part of the newborn screening panel.
15. Explain to the patients regarding follow up of results
Note: The procedure serves as a guideline in determining score/grade of the students. The total grade will be based on the
number of checks. Please follow the procedure accordingly.

Evaluated by

Charisma Rita v. Shavile, RN

Name and Signature of Clinical Instructor