Utilizing a Standardized Bundle of Care to Improve Outcomes for Perinatal Patients with Substance Use Disorder: A Quality Improvement Project.

BACKGROUND: Our interdisciplinary hospital system team used the Alliance for Innovation on Maternal Health (AIM) bundle, Care for Pregnancy and Postpartum People with substance use disorder (SUD), as a framework for program development. Our care teams noted underreporting of perinatal patients with SUD, and once identified, nurses and obstetric providers expressed a knowledge deficit related to the care of this patient population. Using the AIM bundle for guidance, the objectives of this project were to identify pregnant patients with SUD to increase referral rates, provide naloxone at discharge, and treat withdrawal symptoms appropriately through optimization of the electronic medical record.

METHODS: Our team implemented four Plan-Do-Study-Act cycles focused on the AIM bundle and electronic medical record enhancement to drive best practice for this patient population: (1) implementation of a universal screening tool (Audit C+2), (2) trigger of Recovery Nurse Advocate and case management referral based on Audit C+2 results, (3) best practice alert to remind providers to order naloxone based on high-risk screening, and (4) creation of an opioid withdrawal order set to support medication management for perinatal patients experiencing withdrawal symptoms.

RESULTS: Ninety-two percent of perinatal patients admitted to labor and delivery units were screened using Audit C+2, which yielded a high-risk rate of 4% (an increased screening rate of 56% in 2022). Case management and Recovery Nurse Advocate received 46 electronic medical record-triggered referrals. Naloxone distribution rates increased from 0 kits to 7 kits. Providers initiated the withdrawal order set 102 times in 2024.

CONCLUSION: Using a structured framework and leveraging the electronic medical record can help improve outcomes for perinatal patients with substance use disorder.