Developing a Protocol and Educational Program for Pediatric Lead Screening in a Small Rural Vermont Family Medicine Facility

Abstract The Vermont Department of Health (VDH) mandates that all children be tested for lead at 12 months, 24 months, and between three to six years of age, if testing has not been done previously. This quality improvement project was designed to increase lead screening rates at a Small Rural Vermont Family Medicine Facility to meet the state mandate. Barriers included the absence of a formal protocol for preparing for and ordering lead screening, a tool for ordering within the practice's electronic health record, and formal training for all staff on lead screening. The primary intervention involved a protocol change by adding a visual cue in the clinic’s electronic health record in the form of a checkbox to prompt lead screening ordering during well-child visits. The secondary intervention focused on enhancing staff knowledge, confidence, and awareness about lead screening guidelines through an education session, assessed via a pre- and post-education survey. Throughout the study period, the checkbox was utilized, achieving a 58.33% usage rate, an improvement from pre-intervention. Additionally, there was a marked increase in awareness of Vermont’s legal requirements and VDH standards for lead screening in the post-education sessions. Post-implementation surveys revealed a significant increase in provider confidence regarding lead screening, with all providers feeling confident or very confident. All staff found the educational session valuable and reported that it enhanced their knowledge and confidence. This project demonstrated the potential for a protocol change with electronic health record integration and staff education sessions to improve lead screening adherence and foster improved health equity. Key Words: Lead Screening, Electronic Health Record, Education, Provider Confidence, Quality Improvement