764 - Implementation of a Pilot Program at a Level I Nursery to Improve Substance Use Identification Practices

Umbilical cord toxicology testing is performed during birth hospitalizations when substance use during pregnancy is suspected in order to identify families and newborns affected by substance use. There are no standard indications for toxicology testing and universal testing is not recommended. Many institutions use risk-based criteria, which lack supporting evidence and often disproportionately select for patients who may have difficulties accessing healthcare due to language barrier, financial insecurity, and transportation difficulties.

Objective:

The objective was to execute a pilot program removing late initiation of prenatal care as an indication for umbilical cord toxicology testing and to determine rates of substance use identification pre- and post- intervention while reducing the total number of tests ordered and the number of language barrier patients selected for testing.

Design/Methods:

This was a Quality Improvement project that utilized PDSA format to analyze data and drive improvement in umbilical cord toxicology testing practices over the course of 6 months in a level 1 nursery at an academic hospital. Pre-intervention, grant funding was utilized to obtain baseline data in the form of results of umbilical cord toxicology tests on de-identified umbilical cord tissue samples. These results were compared to clinically ordered umbilical cord toxicology results over the same 3-month period. As an intervention, “late prenatal care” was then removed as an indication for toxicology testing from our unit’s policy. Post-intervention, grant funding was again utilized to measure the rates of positive substance use identification from unused, de-identified umbilical cord tissue samples and compared to clinically ordered umbilical cord toxicology test results over another 3-month timeframe. Based on the results, the umbilical cord toxicology testing policy would be updated to reflect the piloted criteria change.

Results:

Substance use identification rates were maintained post-intervention (51%), as compared to baseline rates pre-intervention (48%). There was a decrease in the percent of non-English speaking birthing persons selected for by the criteria post-intervention (15.5% compared to 32%) and a decrease in the number of tests ordered by ~5/month.

Conclusion(s):

Removal of late prenatal care from policy criteria used to obtain umbilical cord toxicology testing did not alter rates of substance use identification, but did reduce the total number of tests ordered and the number of language barrier patients selected for toxicology testing.