Understanding and addressing bias in urine drug screening protocols on high-volume labor and delivery units

BackgroundThe purpose of this study was to understand the current demographics and characteristics of patients undergoing urine drug screening on labor and delivery units with the intention of using this data to create a more evidence-based, equitable policy to reduce bias in the screening process.MethodsA retrospective chart review was performed of 509 instances of drug screening occurring for pregnant and recently delivered patients across three hospitals in Omaha, Nebraska. Demographics of patients, including age, race, ethnicity, and insurance status, as well as reasons for drug screening, patient consent, screening results, and disclosure of results, were analyzed to assess patterns in screening.Results509 screening instances were evaluated with 324 unique patients. While Black patients made up 11.6% of the overall patient population, they accounted for 26.2% of the patients undergoing urine drug screenings. 2.88% of all patients self-identified as Hispanic; however, they comprised 13.4% of all patients screened. Consent was documented in 11.3% of cases and a reason for obtaining UDS was documented in 61.5% of cases. The most common reasons cited were history of substance use or current use, medical indications, and suspected use without documented history of use.ConclusionsEstablishment of more specific, evidence-based policies for urine drug screening may reduce the impact of implicit biases on current screening practices and serve as one avenue to rebuild trust with patients who have historically been marginalized by the medical community.