Intrauterine substance exposure is a nationally growing problem. A steady increase in neonates with neonatal abstinence syndrome in the state of Ohio was noted. Prenatal substance use presents a significant burden to society. Of infants exposed to intrauterine opiates, 55-94 percent develop signs of withdrawal. For example, the estimated lifetime cost for a neonate with fetal alcohol spectrum disorder is $2 million. The purpose of this evidence based practice improvement project was to evaluate the utility of the 5Ps screening tool and brief intervention by community health workers during the first prenatal home visit. The Evidence-Based Practice Improvement (EBPI) model guided the project. The prenatal screening tools previously used by community health workers focused on only one substance and asked primarily direct questions. Evidence supports asking a combination of direct and indirect questions for improving recognition of risk. Screening followed by a brief intervention suggests improvement in patient outcomes. Community health workers caring for prenatal women were educated about the use of the 5Ps tool, motivational interviewing and practice of a brief intervention. Sixteen staff members were surveyed before and after the education. Staff outcome measures were ease of use, comfort with, and intention to use the 5Ps tool. Patient outcomes included use of the 5Ps, identification of risk, and documentation of iv discussion or intervention. A significant difference was noted between total average score on the pretest (M=27.12, SD=11.29) and total average score on the posttest (M=14.81, SD=9.99) p< .001. Particularly, there was a significant difference in staff member’s knowledge of the 5Ps tool (p< .031). Retrospective chart review before and after staff education revealed a significant difference in the use of the 5Ps, p< .022. Individually, there was a significant difference in documentation of a substance intervention or discussion p< .030. Further study with a larger sample size is needed to determine the effect of the 5Ps tool on the prenatal population served by community health workers. Staff involved in treating pregnant women benefited from education in motivational interviewing and use of a brief intervention.
Jasin, L. R. (2015). Alcohol, Tobacco and Illicit Drug Screening in Pregnancy. . Wright State University, Dayton, OH.