Consent to drug test OB/L&D Patients

[JMA-RN2B]

Currently, the hospital I work at performs urine drug tests to patients who meet certain requirements like no prenatal care, questionable appearance or behavior, low birth weight, still birth or miscarriage, any hx of use...you get the point. The patients are not informed they have even been tested unless the test comes back positive-then the social worker is called and she's who tells them.

A new policy is in the process of being passed about having the patients sign a consent for this testing. If the patient refuses, they plan to test the baby without permission after birth with the refusal as "reasonable cause". I don't see the point in the policy (I support the random tests), but I was wondering if anyone else works where they have this rule?

[justme1972]

I can already tell you a problem that you are going to run into.

At the hospital where I externed this summer, there was a very high rate of drug babies.

This hospital did as close to the first urine as possible and first meconium.

All the parents were told is that we needed to do "testing" and to leave the urine catch bag on the baby...call us when it was full, or to not throw away the diaper if the baby pooped b/c we needed a sample.

These drug Mom's were not aware of why we were doing the testing..they thought it was normal.

Now, imagine if you TOLD these mom's testing would be done...and then trying to get those samples.

Ain't gonna happen.

To me, if the way the law works, if you can test without consent, then it should be done without consent...it's about protecting the infant, not Mom...I'm with you...makes no sense.

[Batman24]

I would post this in OB forum as well as they might have more info.

Just curious if they are charging the patient for the test. I would deny the test as I know I'm clean and wouldn't want to pay for something that isn't needed. I would hate to think that would be a sign to them I might be lying as not everyone they think is doing drugs will be doing them.

My guess is this went through the hospital attorney and this is legal but they better pick up the cost. I would also be livid if test was done to my baby without my okay and I think those that are clean will feel the same way. I can see why you are leery.

[Atheos]

Isn't illegal to run a test without consent. Really don't know that one.

Also, to avoid any problems, why not just always test the baby instead? You can make a legitimate argument about testing a baby with or without legal interference.

[APBT mom, LPN, RN]

Just curious as to why they test the mother's and infants of patients who fit the description of being a drug user. I use to work at an OB/GYN and we tested everyone on their first appointment. You'd be surprised on how many people who didn't fit the description came back positive while the ones who did passed.

They only thing that I think would help is if you looked up ACOG guidelines on testing to see if consent is needed.

I don't understand why the hospital wants to get consent and then if the mother says no they'll just test for due to "just cause". Seems like extra work for nothing. I wouldn't feel comfortable asking a mother for consent, having them say no, and then testing the infant anyway.

[sample24]

I'm sure my take on this is most likely controversial. I happen to work in a women's hospital and my view is test EVERYONE that walks in the door. If you have nothing to hide, you won't mind it. As tampagirl stated: you'd be surprised the people that don't "fit the description" and test positive.

There are so many people that you can tell by their behavior that 'something is up.' We aren't allowed to test w/o a doctor's order, and there aren't many of our MD's who are willing to let us do it just because we have a gut feeling.

It's really hard to catch a baby's first urinary o/p. Many times they void immediately after delivery and you can't catch it. I'd much rather get a speci from mom when she comes in than try to get it from the infant.

Just my

[ILuvNewBabies!]

In my L&D dept. every woman submits a urine sample and a tox screen is done as part of our "labor panel" of tests. The only test on that labor panel that needs a written consent is the HIV test.

[moongirl]

In my dept, a test is run if criteria is met- late to care, no prentatal care, hx of drug use,preterm labor. BUT- we have to ask for consent, they can refuse. If they do, then baby is automatically tested.

also, if there is any hx at all, even if their urine is clean, we do a mec stat on the baby

[ilstu99]

We test all babies. A trip to the NICU means you automatically meet the criteria.

IMO - "reasonable cause" is "you are my patient and I need to know what's going on to treat you effectively and safely." I'm not here to arrest you, or lecture you about your stupid choices....just keep you healthy.

[moongirl]

We test all babies. A trip to the NICU means you automatically meet the criteria.

IMO - "reasonable cause" is "you are my patient and I need to know what's going on to treat you effectively and safely." I'm not here to arrest you, or lecture you about your stupid choices....just keep you healthy.

amen to that.

[justme1972]

I would post this in OB forum as well as they might have more info.

Just curious if they are charging the patient for the test. I would deny the test as I know I'm clean and wouldn't want to pay for something that isn't needed. I would hate to think that would be a sign to them I might be lying as not everyone they think is doing drugs will be doing them.

My guess is this went through the hospital attorney and this is legal but they better pick up the cost. I would also be livid if test was done to my baby without my okay and I think those that are clean will feel the same way. I can see why you are leery.

Here is the thing...a lot of these drug mothers claim to be clean...so you can't use that as a criteria. They know if they admit to drug use it's an automatic social services referral...so they just take the chance that the test may come back clean.

If they are given the option, they'll most likely decline the test.

[JMA-RN2B]

Thanks for all your input. To answer some of your questions. They run the simple 7 test when we ask and yes. Yes, they are charged for the test. I would guess 75% or more of our patients are Medicaid so they probably don't care too much about that. We have a pretty high rate of positive drug tests when we're suspicious-mostly cannibas.

I think maybe a drug test should be standard in triage and even if we had a consent, they would know everyone gets tested.

Like one of you said-its about treating the baby and knowing what to expect with them. I'd like to know if we're going to fight withdrawl issues with them first.