Acceptability of an Asynchronous PowerPoint for Increasing Provider Knowledge of Childhood Lead Screening: A Quality Improvement Project

Abstract

Purpose: The purpose of this DNP Project was to increase the number of children screened for lead toxicity by identifying and addressing barriers to guideline adherence. Background: Elevated blood lead levels (BLLs) are associated with reduced intelligence, lower school achievement, and behavior disorders. Exposure to lead results in an estimated 400,000 deaths annually, comparable to the mortality from tobacco smoke. 500,000 U.S. children between 1 and 5 are estimated to have elevated BLLs, with low-income and minority families particularly affected. Locally, this issue is a priority because only 4.5% of children under 6 in Pima County’s high-risk zip codes received both recommended blood lead tests in 2016. Methods: A 15-minute electronic survey was emailed to four primary care providers at a family practice clinic. Informed by Ajzen’s Theory of Planned Behavior, the survey included: 1) Knowledge of state and federal lead screening guidelines; 2) Attitudes regarding lead screening; and 3) Perceived barriers to consistent screening and reporting. All participants received a targeted educational PowerPoint presentation that included accurate information about lead toxicity and current lead screening guidelines, and were asked to complete a post-survey evaluating its effectiveness. Outcomes achieved: Three health care providers responded to the survey (75% response rate), including two nurse practitioners and one physician. The mean knowledge score was 37%, with no correct responses to questions about the ages at which testing is required and unnecessary or wasteful testing procedures. Attitudes towards testing were generally positive. Identified barriers included not knowing where to find current guidelines, perceiving CDC guidelines as difficult to follow, and lack of provider education. The PowerPoint addressing these learning needs was positively rated by participants. Project findings were shared with clinic site management to facilitate employee training and clinical processes. Conclusions: Future directions include repeating this project with a larger sample of clinicians. Additional promising interventions from the literature include office system improvements, preventive care bundles, in-house capillary testing, and electronic medical record prompts. Nurse practitioners are notably absent from the literature on attitudes and barriers to lead screening, and future research should aim to be more inclusive of advanced practice nurses.