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Implementation of a Universal Screening Process for Substance Use in Pregnancy
Micah Ulrich1, Elise Petersen Memmo, Alissa Cruz
1Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts.
Insights
Implementing universal substance use screening in prenatal care is feasible, identifying at-risk patients. Sustaining documentation of brief interventions for positive screens requires further effort.
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Healthcare Quality Improvement
Background:
- Substance use during pregnancy poses significant risks to both mother and child.
- Standardized screening processes are crucial for early identification and intervention in prenatal care settings.
- Existing screening methods may not be universally applied in diverse clinical environments.
Purpose of the Study:
- To implement and evaluate a standardized universal substance use screening process for prenatal patients.
- To assess the feasibility and effectiveness of integrating the 5Ps screening tool and SBIRT model into routine prenatal care.
- To measure the rates of screening completion, positive screens, and subsequent interventions.
Main Methods:
- A quality-improvement framework utilizing process modeling and plan-do-study-act cycles was employed.
- A modified 5Ps (Parents, Peers, Partner, Past, Present) screening tool was adapted for universal use.
- The Screening, Brief Intervention, Referral to Treatment (SBIRT) model guided the intervention workflow.
Main Results:
- A substance use screen was completed in 84% of 733 patient encounters over 19 months.
- Screening rates exceeded the 90% goal in the final six months of data collection.
- 20% of screened patients tested positive, with intervention documentation reaching 80% initially but declining to 50%.
Conclusions:
- A sustainable and generalizable universal substance use screening process is achievable in large prenatal clinics.
- The screening process successfully identified patients not previously known to be at risk.
- Sustaining healthcare practitioner documentation of interventions for positive screens remains a challenge requiring further investigation.
Objective:
To implement a standardized universal substance use screening process in an outpatient prenatal clinic at an urban tertiary care hospital.
Methods:
Using a quality-improvement framework that involved process modeling, stakeholder analyses, and plan-do-study-act cycles, we implemented universal substance use screening for prenatal patients using a modified 5Ps screening tool (Parents, Peers, Partner, Past, Present). Implementation included an operational workflow based on the SBIRT (Screening, Brief Intervention, Referral to Treatment) model. The primary outcome measure was percentage of patients who were screened for substance use, with a goal of 90% screened. Secondary outcome measures were percentage who screened positive and percentage of the time a positive screen resulted in documentation of a brief intervention by a health care practitioner.
Results:
Over a 19-month implementation period, 733 patient encounters were sampled. A substance use screen was completed in 618 (84%). We exceeded our goal of screening 90% of eligible patients for the final 6 months of data collection. Of the 618 completed screens, 124 (20%) screened positive. Health care practitioner documentation of brief interventions for patients with a positive screen reached 80% in the final phase of implementation, but then declined to 50% by the completion of the study period.
Conclusion:
A sustainable and generalizable process to carry out substance use screening within a large prenatal practice is feasible, and assisted with identification of patients not known to be at risk. Further efforts are needed to evaluate how to sustain health care practitioner documentation of intervention in response to positive screens.
