Implementing SBIRT for Substance Use Identification and Intervention at the Initial Obstetrical Visit

Background: Substance use in pregnancy is a substantial public health issue in the United States. Screening for substance use disorder (SUD) in pregnancy has the potential to identify a pregnant individual with SUD, provide brief intervention, and referral to treatment, with the potential to improve maternal and neonatal outcomes. Local Problem: There was an increase of 11.4% in the rate of opioid use disorder diagnoses during pregnancy in Erie County, PA for women with medical assistance from 2016 to 2020. Methods: In this quality improvement project screening, brief intervention, and referral to treatment (SBIRT) was introduced during a staff in-service. Screening, brief intervention, and referral to treatment rates were measured and compared to pre-implementation rates. A survey was circulated to nurses and providers to assess acceptability, appropriateness, and feasibility of SBIRT. SBIRT was implemented. The same survey was circulated post-implementation. Interventions: Screening for SUD in pregnancy was performed by nursing staff. Brief intervention, and referral to treatment, if applicable, was performed by obstetrical provider. Results: Screening for SUD increased from 88.6% to 93%. There were six positive NIDA screens with no appropriate brief intervention and referral to treatment performed. The staff found that SBIRT is acceptable, appropriate, and feasible. There was no statistically significant change between pre- and post-implementation surveys of the AIM, IAM, and FIM of SBIRT. Conclusions: The completion of brief intervention and referral to treatment faced barriers in a suburban outpatient obstetrical setting. Further research is warranted for recommendations to overcome these barriers.