Evaluation of Universal Screening for Substance Use Risk on a Labor and Delivery Unit in Rural Pennsylvania

Objective: To evaluate a newly implemented universal screening process for substance use on a labor and delivery (L&D) unit. Design: Focused program evaluation using the Centers for Disease Control and Prevention Framework for Program Evaluation in Public Health. Setting/Local Problem: An L&D unit in a community hospital that was part of a larger health system located in rural Pennsylvania with higher than state average rates of perinatal substance and opioid use. Participants: Women (n = 570) admitted to the L&D unit between July 2021 and July 2022 and the maternity care providers (i.e., nurses, certified nurse-midwives, and physicians; n = 22) on the L&D unit. Intervention/Measurements: We analyzed screening rates; provider follow-up rates for at-risk screens; and staff perception of acceptability, appropriateness, and feasibility of the National Institute on Drug Abuse Quick Screen and the modified Alcohol, Smoking, and Substance Involvement Screening Test (NIDA Quick Screen/ASSIST). We also collected staff feedback with open-ended questions in a survey. Results: The screening rate on the L&D unit during the study period was 89%. Maternity care providers ordered the appropriate follow-up on at-risk screens 88% of the time. Nurses and providers found the NIDA Quick Screen/ASSIST to be an acceptable, appropriate, and feasible screening tool for identifying substance use risk. Conclusion: The screening rate on the L&D unit was greater than the health system goal of 80%, whereas the provider follow-up rate was less than the goal of 100%. In open-ended feedback, staff identified ways to streamline the screening process; improve nurse, provider, and patient education; and enhance patient follow-up.