Implementation of a Universal Screening Process for Substance Use in Pregnancy

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.