Anil K Chokkalla, Sahil Malik, Ridwan Ibrahim, Sridevi Devaraj
{"title":"妊娠期异常尿液药物筛查-实验室管理的机会。","authors":"Anil K Chokkalla, Sahil Malik, Ridwan Ibrahim, Sridevi Devaraj","doi":"","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Clinical testing for drugs of abuse typically involves initial screening followed by confirmatory testing. Due to limited evidence-based guidelines, the healthcare provider makes the decision to confirm abnormal screens based on the clinical context. This two-step approach proved to be inadequate in scenarios like maternal substance abuse and subsequent fetal/ newborn exposure. The goal of this study is to assess and improve the confirmatory testing rate of abnormal screens among pregnant patients at our women's center.</p><p><strong>Methods: </strong>A retrospective chart review was conducted to assess the confirmation rates among positively screened pregnant patients, and a lab stewardship initiative was implemented to remind ordering physicians about the importance of confirmatory drug tests. Abnormal screens were classified as expected positives based on the medication-related interference, social history and self-reported substance use from the provider notes.</p><p><strong>Results: </strong>Only 28% of pregnant patients with unexpected positive drug screens underwent confirmatory testing during the pre- intervention period, which rose significantly to 67% during the post-intervention period. Furthermore, outcome analysis revealed that 50% of patients with concordant confirmatory test results were referred to social work and psychiatry in the post-intervention period.</p><p><strong>Conclusions: </strong>This study highlights the value of laboratory stewardship in optimizing drug testing practices for pregnant patients.</p>","PeriodicalId":37192,"journal":{"name":"Electronic Journal of the International Federation of Clinical Chemistry and Laboratory Medicine","volume":"36 1","pages":"83-87"},"PeriodicalIF":0.0000,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886620/pdf/","citationCount":"0","resultStr":"{\"title\":\"Abnormal Urine Drug Screens in Pregnancy- Opportunity for Laboratory Stewardship.\",\"authors\":\"Anil K Chokkalla, Sahil Malik, Ridwan Ibrahim, Sridevi Devaraj\",\"doi\":\"\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Clinical testing for drugs of abuse typically involves initial screening followed by confirmatory testing. Due to limited evidence-based guidelines, the healthcare provider makes the decision to confirm abnormal screens based on the clinical context. This two-step approach proved to be inadequate in scenarios like maternal substance abuse and subsequent fetal/ newborn exposure. The goal of this study is to assess and improve the confirmatory testing rate of abnormal screens among pregnant patients at our women's center.</p><p><strong>Methods: </strong>A retrospective chart review was conducted to assess the confirmation rates among positively screened pregnant patients, and a lab stewardship initiative was implemented to remind ordering physicians about the importance of confirmatory drug tests. Abnormal screens were classified as expected positives based on the medication-related interference, social history and self-reported substance use from the provider notes.</p><p><strong>Results: </strong>Only 28% of pregnant patients with unexpected positive drug screens underwent confirmatory testing during the pre- intervention period, which rose significantly to 67% during the post-intervention period. Furthermore, outcome analysis revealed that 50% of patients with concordant confirmatory test results were referred to social work and psychiatry in the post-intervention period.</p><p><strong>Conclusions: </strong>This study highlights the value of laboratory stewardship in optimizing drug testing practices for pregnant patients.</p>\",\"PeriodicalId\":37192,\"journal\":{\"name\":\"Electronic Journal of the International Federation of Clinical Chemistry and Laboratory Medicine\",\"volume\":\"36 1\",\"pages\":\"83-87\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-02-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886620/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Electronic Journal of the International Federation of Clinical Chemistry and Laboratory Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/3/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Electronic Journal of the International Federation of Clinical Chemistry and Laboratory Medicine","FirstCategoryId":"1085","ListUrlMain":"","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
Abnormal Urine Drug Screens in Pregnancy- Opportunity for Laboratory Stewardship.
Background: Clinical testing for drugs of abuse typically involves initial screening followed by confirmatory testing. Due to limited evidence-based guidelines, the healthcare provider makes the decision to confirm abnormal screens based on the clinical context. This two-step approach proved to be inadequate in scenarios like maternal substance abuse and subsequent fetal/ newborn exposure. The goal of this study is to assess and improve the confirmatory testing rate of abnormal screens among pregnant patients at our women's center.
Methods: A retrospective chart review was conducted to assess the confirmation rates among positively screened pregnant patients, and a lab stewardship initiative was implemented to remind ordering physicians about the importance of confirmatory drug tests. Abnormal screens were classified as expected positives based on the medication-related interference, social history and self-reported substance use from the provider notes.
Results: Only 28% of pregnant patients with unexpected positive drug screens underwent confirmatory testing during the pre- intervention period, which rose significantly to 67% during the post-intervention period. Furthermore, outcome analysis revealed that 50% of patients with concordant confirmatory test results were referred to social work and psychiatry in the post-intervention period.
Conclusions: This study highlights the value of laboratory stewardship in optimizing drug testing practices for pregnant patients.