140 - Improving the Follow-up of Positive Meconium Drug Screens in Newborns Discharged From the Nursery

Poster Number: 140
Publication Number: 140.1353

Background: As opioid use has increased, newborns are more frequently screened for in-utero substance exposure due to maternal risk factors. Meconium drug screening, the gold standard for detection of fetal drug exposure, is often pending at discharge. Post-discharge follow-up of pending test results is challenging due to the short length of stay and multiple-day delay between discharge and drug screen results. We noted gaps in our follow-up process of pending meconium drug screen results. Notification of primary care providers and referral to child protective services (CPS) for positive results is recommended by our state and is crucial to providing families with needed support and services.

Objective: To improve documented appropriate follow-up of positive meconium drug screen results for newborns discharged from the mother-baby unit (MBU) to 100% within 6 months.

Design/Methods: We gathered key stakeholders at our nested, tertiary care children’s hospital and utilized the A3 thinking/approach to analyze contributing factors to missed positive meconium drug screen follow-up and identified key drivers. We mapped the baseline process and identified the responsibilities of each multi-disciplinary team member. Via iterative PDSA interventions, we developed standard work to ensure follow-up and documentation via an automated report in the electronic medical record (EMR) of pending results at discharge and a standard searchable “dot phrase” for social work follow-up documentation. Data for newborns discharged from the MBU with ordered meconium drug screens were collected including demographics, screen results, and documentation of follow-up of results. Data were analyzed during baseline (7/28/22-1/19/23) and intervention (1/20/23-8/31/23) periods. Our primary outcome was the proportion of infants with a positive meconium drug screen with appropriate documented follow-up within three weeks of discharge, monitored and analyzed on a statistical process control p-Chart.

Results: A total of 108 newborns with positive meconium drug screens were included in our analysis, with 55 newborns in the intervention period. Tetrahydrocannabinol alone was the most common positive result found in 47 infants. Following our intervention, we increased the proportion of infants with positive drug screens with appropriate follow-up from a baseline of 60% to 100%.

Conclusion(s): By utilizing QI methodology, we were able to improve our process for follow-up of positive meconium drug screens to avoid missing results and improve continuity of care for newborns discharged from our MBU.