Dear Team clOUDi,
One of our key aims in this initiative is to screen every expectant mother in North Carolina with a validated verbal screening tool for the possibility of opioid use disorder. There are several tools which might be used and I refer you to the most excellent webinar delivered by Melinda Ramage and Dr. Hendree Jones located here on the PQCNC site.
While many of us do not have a validated verbal screening tool incorporated…yet…into our EHRs, many of your patients have already been screened in their maternal clinic with a validated tool. The DMA Pregnancy Medical Home (PMH) has been performing high risk screening for all Medicaid mothers for almost a decade. The DMA tool is "Care Management for High Risk Pregnancies" (CMHRP). It covers much of the same information as is found in the 5Ps screening tool although the language has been modified.
From Dr. Jones, “The 4Ps, the 4Ps + , and the 5Ps would all be considered variations of the same tool (with different data to support them in sensitivity and specificity), but the goal is to use whatever of these tools you have in a patient centered way, not re-invent the wheel).”
So here’s the challenge. If you like the fact that a screening tool is being used by the PMH Case Managers team prenatally, it would be great to consider how to this information into your admissions process on Labor and Delivery, or your HER. The screen for perhaps 50% of mothers has already been done but we are often not accessing this data on the hospital side of maternity care.
The real opportunity to build a robust screening process, however, is to make certain the screening tool is used in a manner that is non-threatening, non-stigmatizing and increases the likelihood a mother will disclose and perhaps accept the possibility of support and intervention for a substance use problem.
From Melinda Ramage, “the key is who administers the screen, how they administer it, and if it is a Medicaid Case Manager in a clinic, how it gets documented in the chart since it is technically generated and recorded on another form for another system.”
So no need to recreate a validated screening tool wheel. There is one being used in North Carolina for many moms. How to administer it effectively and communicate the results is the challenge….and the opportunity.
Thank you for your commitment to making North Carolina the best place to give birth and be born!