Hemoglobin Iron Determination

POLICY:

NOCAC Child Development will ensure all participants are screened for iron deficiency utilizing results from a Hematocrit or Hematocrit/Hemoglobin (HCT/HGB) blood test within 90 calendar days of enrollment.

REQUIREMENTS:

Early Head Start enrolled participants:

1. For a participant enrolled before the age of 12 months, the program must obtain documentation that a HCT/HGB screening was completed.
2. If there is no documentation that a screening was performed at 12 months, a screening must be performed as soon as possible.  A second HCT/HGB screening may be required to be performed for the participant at 24 months of age based on the primary care physicians risk assessments results.

Head Start enrolled participants:

1. The program is required to obtain documentation that a HCT/HGB screening was performed between the ages of 36-72 months.
2. If there is no documentation that a screening was performed after 36 months of age, a screening must be performed within 90 days of enrollment.

PROCEDURES:

1. At the initial home visit, the teacher/Home Visitor (HV) will inform parents of the program’s health requirements and determine if the participant is up-to-date on the recommended schedule.
2. NOCAC staff or Health and Safety Manager will assist the family in arranging for and obtaining HCT/HGB screening results.
   1. The parent will be asked to provide the program with the HCT/HGB screening date and results from their local WIC provider or primary care physician.
   2. If needed, the parent may sign a Release of Information form allowing the program to obtain the results from WIC or primary care physician.
   3. If NOCAC has not received a copy of the HCT/HGB screening date and results from their local WIC provider or primary care physician within approximately two weeks after sending the Release of Information, a second request will be mailed.
   4. If two weeks after mailing the second request the program has not received a response, the HCT/HGB screening will be performed by the health staff with signed parent permission.
3. When a determination has been made that the participant has not been screened for iron deficiency or the results of a previous screening cannot be obtained, NOCAC Health/Safety Manager will perform the HCT/HGB screening, the following will be adhered to:
   1. A finger stick lead screening will be performed by licensed personnel or health staff who have been trained and show proficiency in this skill.
   2. Parents will be notified when the screening will be performed.
   3. NOCAC Staff will assist parent to complete Child Lab paperwork which authorizes a finger stick.
   4. A Child Lab permission form must be completed prior to the screening being performed.
   5. Verification of parent signature on a parent agreement of services with the HCT/HGB screening marked appropriately will be done.
   6. Notification of screening results will be given to the parent as soon as possible after all screenings are completed by providing the parent with a copy of the results.
4. The following guidelines will be utilized to determine a child’s need for referral for treatment and followup.
   1. Followup on participants that fail the HCT/HGB screening will be completed by the primary care physician
   2. NOCAC Staff will assist the parent in making and keeping appointments or arranging transportation.
5. HCT/HGB screening results will be recorded in ChildPlus.
6. Participants will not be excluded from the program because of incomplete the HCT/HGB screening.
7. Pass/Fail Levels:
   1. Any hemoglobin at or above 10.1 is considered a pass.
   2. Any hemoglobin between 10.0 or below is a fail and requires an automatic referral to Health/Nutrition Services.  This referral must be completed within two weeks of the date the results were received by staff.
   3. Any hematocrit at or above 34.1% is considered a pass.
   4. Any hematocrit at 34% or below is a fail and requires an automatic referral to the Health/Nutrition Services.  This referral must be completed within two weeks of the date the results were received by staff.
8. If after 90 days from the participant’s enrollment date staff are unable to obtain a hemoglobin/hematocrit screening for any participant regardless of age, the participant must be referred to the Health Manager. Staff must include all dates they have spoken/contacted the parent regarding the missing hemoglobin/hematocrit with the referral.
9. NOCAC is the payor of last resort.

Forms and Additional Guidance:

• Iron Deficiency in Children
• Release of Information form