Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

9-18-2024

Graduate Advisor

Vanessa Loyd PhD, DNP, RN

Committee

Elise Schaller DNP, MHA, APRN, CPNP-PC

Lanae Romann RN, MSN

Abstract

Abstract

Background: In the United States, 10-20% of pregnant women reported using drugs during pregnancy. Current recommendations are to screen for drug use in all patients and provide a brief intervention and referral to treatment. The purpose of this quality improvement project was to evaluate the impact of implementing a standardized screening, brief intervention, and referral to treatment (SBIRT) protocol for first-trimester pregnant patients who are seen in the obstetrical department.

Methods: The Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) screening tool was administered to first-trimester pregnant women, 13-45 years of age, seen in the obstetrical department from February through May 2024. Data was collected via retrospective chart review and included patient information such as age, gestational age, provider type, gravida, substance use screening results, brief intervention documentation, and referral to treatment. The Johns Hopkins Nursing Evidence-Based Practice model served as the framework.

Results: First-trimester pregnant patients (N=359) were seen in the obstetrical department with (n=119) having positive TAPS screenings; (n=92) were eligible for a brief intervention; (n=7) had an initial and repeat urine drug screen. There was no statistical difference between initial and repeat urine drug screen results.

Implications for practice: SBIRT has been documented as an effective protocol to identify and reduce substance use in pregnant women. Provider (physicians, certified nurse midwives, and family nurse practitioners) training should include adverse patient outcomes with missed documentation. Brief interventions and referrals to social workers are essential for those who screen positive for drug use in pregnancy.

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