Improving Early Detection and Management of Prenatal Substance Use Disorder

Introduction

Substance use disorder (SUD) in pregnancy poses undesirable effects on both mother and child. ACOG recommends universal screening at the initial prenatal visit using validated screening tools to identify prenatal substance and alcohol use. There are various barriers to early detection. However, providers have a unique chance to screen and identify high-risk patients during the prenatal period. Timely intervention can prevent continued substance use and improve maternal-fetal outcomes. This study aims to improve St. Barnabas Hospital's (SBH) approach to identification and management of patients with SUD by implementing the 4P screening tool into the EMR.

Methods

A retrospective chart review of SBH prenatal patients was conducted after the 4P screening tool was added to the EMR. Patient charts with a positive screen were reviewed for documentation of a brief intervention and plan of safe care. 50 unscreened patient charts were reviewed for documentation of other positive screening tools related to drugs and alcohol.

Results

314 prenatal patients were seen between 1/1/2024 and 2/29/2024. Of the 162 prenatal patients seen in January, 41% were screened and 2% resulted in a positive screen with a documented brief intervention. Of the 152 prenatal patients seen in February, 52% were screened with no positive results. Among the 50 charts reviewed without a 4P screen, three patients self-reported active nicotine use during pregnancy.

Conclusion

Implementing the 4P screening tool into the EMR may improve documentation of SUD in pregnancy. Tracking screening rates and interventions can be vital in enhancing SUD detection.