Introduction: The opioid epidemic cost Massachusetts $15.2 billion dollars in 2017. Massachusetts has some of the highest rates of opioid related deaths in the United States. In 2018, there were 1,617 confirmed opioid-related overdose deaths, and approximately 30% of these deaths were among women. Nationally, a majority of prenatal patients (70%) are screened for drug, tobacco or alcohol use, yet the rates in Massachusetts are not known. The purpose of this project is to ensure that all prenatal patients are screened for substance use. This was made possible through the Maternal-Child health Nurse Leadership Academy (MCHNLA) which is sponsored by Johnson & Johnson.
Methods: This cross-sectional quality improvement project was developed to screen new pregnant patients at their first prenatal visit at The Dimock Center. Inclusion criteria for participation in the quality improvement project was that the women be pregnant and attending their first prenatal visit.
Measure: The measure for this QI project was the Screening to Brief Intervention Tool (S2BI) (NIDA, 2011), a 5-item, standardized assessment tool with a Likert scale. The brief screening was initiated to identify women’s prenatal substance use.
Procedure: The S2BI was included in the patient’s health history packet. The medical assistants who roomed the women instructed the patients about completing the survey, and instructed them to give the measure to the healthcare provider seeing them after the survey was completed.
Data Analysis: Excel will be used to analyze the data and obtain frequencies and descriptive data.
Project Outcomes/Results:
Data for this QI project was collected between September 2018 and April 2019. The surveyed population (92 participants) included 62% English speakers and 38% Spanish speakers. Participants ranged in age from 15-40 years of age, with the majority (70%) between 21-30 years of age.
All of new pregnant patients (100%) were formally screened for substance use in the past 12 months. Weekly substance use was reported for the following: Marijuana (16%), Tobacco (9%), alcohol (4%), prescription drugs (3%), recreational drugs (3%), and inhalants or herbs weekly (0%).
Discussion: Prior to the initiation of this study, no formal screening tool for substance use among pregnant patients was being used at The Dimock Center. The use of this tool allowed for the identification of patients who could benefit from substance use intervention. Patients who had a positive screen all were offered behavioral health and addiction recovery services. Additionally, the screening process facilitated the opportunity for education regarding substance use and the implications it can have on a healthy pregnancy. Given the success among pregnant women at The Dimock Center, an expansion to survey all OBGYN patients regardless of pregnancy status is planned in the near future.