Drug screening practices and policies of labor and delivery units in the southeastern United States: considerations, implications, and unintended consequences

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
Dolly Pressley Byrd (Creator)
The University of North Carolina at Greensboro (UNCG )
Web Site: http://library.uncg.edu/
Robin Bartlett

Abstract: The purpose of this study was to investigate the types of drug screening practices and policies adopted by Labor & Delivery (L&D) units across the southeastern United States. Enacted in 2003, the Keeping Children and Families Safe Act Public Law 108-150 requires hospitals receiving federal funds to develop perinatal drug screening protocols to identify infants with illicit substance exposures in-utero in order to provide appropriate treatment and facilitate reporting to Child Protective Services (CPS) or Department of Social Services (DSS). Despite this legislative mandate, there are no standardized clinical recommendations to guide policy formulation or implementation, and hospitals have adopted various institution-specific policies. This dissertation project explored (a) what drug screening protocols L&D units across the southeastern United States implement for women in labor; (b) whether adoption of selective drug testing protocols differs based on institution type, hospital size, or predominant payer source; (c) what maternal or newborn risk factors trigger drug testing on selective screening protocols; and (d) whether maternal and newborn risk factors that trigger testing differ based on hospital characteristics. Two separate, complementary manuscripts are included in this dissertation. The first manuscript describes an outcomes project that surveyed L&D administrative personnel regarding perinatal drug testing policies adopted at their institutions. Additionally, an integrative literature review manuscript explored the various types of perinatal substance use screening protocols, whether guidance on best practices or approaches were available, and identified typical maternal or newborn risk factors that precipitated drug testing. This project was guided by an intersectional theoretical framework to examine whether perinatal selective drug screening protocols serve as a form of structural discrimination that marginalize pregnant women of color, low social location, or with illicit substance use. This outcomes project used a descriptive quantitative cross-sectional research design with purposive sampling to query institutional L&D units across seven southeastern states. A 34-item questionnaire created by the principal investigator collected hospital characteristics (e.g., facility type, predominant payor source) and demographic data of the patient population served. Additionally, survey items sought information regarding hospital drug screening policies implemented and criteria for toxicology testing. A sample of 49 L&D nurse managers and Women’s Services Directors completed the online survey. Participants responded from all seven states of interest, representing institutions of various sizes ranging from 25 to 1,500 hospital beds. The majority of respondents (63.3%) were from not-for-profit facilities with Medicaid as the predominant payor source (87%). Over three-quarters (80.4%) of survey participants reported formal perinatal drug testing policies adopted by their L&D units. Based on the survey employed for this dissertation, hospitals most frequently adopted selective drug testing policies, protocols that require toxicology testing if established maternal or newborn risk factors are present. Current illicit substance use, past history of drug use, or medication assisted treatment (e.g., Methadone or buprenorphine) most frequently triggered drug testing. Some selective drug testing protocols also included other obstetrical or behavioral risk factors as criteria for testing. There were no differences in institution type, hospital size, or predominant payor sources for L&D adoption of selective drug testing protocols. Risk factors triggering testing on selective protocols did not differ based on these hospital characteristics. These exploratory findings provide a foundation for further research examining selective drug testing protocols and could inform hospital policy development and implementation practices. Future development of best clinical practice recommendations and standardized protocol guidelines could help ensure such policies are equitably applied to all women, reducing risk of implicit bias or disproportionate CPS or DSS referrals for women of color or low social location.

Additional Information

Language: English
Date: 2020
Informed consent, Labor, Pregnancy, Substance abuse detection, Substance-related disorders, Surveys and questionnaires
Hospitals $x Maternity services $z Southern States
Substance abuse in pregnancy
Substance abuse $x Testing

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