Ok, I'll get right to the point.
Most of the nurses at the hospital I work at have always worked here, we deliver about 600/yr. I don't know who to ask or where to start. I really feel the need for some help for our drug abusing moms, and babies. We don't see much of it, but we are seeing more and more. We have no policy, no standards to guide us. If a woman comes in with no prenatal care, we ask the doc if we can get a UDS. That's pretty much it. I've recently had one who quit using 6 mo before her 1st ob appt....and no random or any drug screen during her pregnancy at all. When we do get a pos we call the child abuse hotline and I personally have gotten the response anywhere from they can't do anything unless the baby shows a pos screen, to being up in the dept within hrs (I'm assuming those probably were already in the system). We had our first full blown withdrawal baby over the weekend, and the nurses sat on it all evening/ night and into the day shift....stating, well his resps are over 100 because he's withdrawling...he's sweating and screaming etc because of that....when they finally did call, the doc ruled out infection with bc, cbc, cxr, ekg (which was next to impossible to get), THEN consulted someone at a bigger hospital and gave the little guy phenobarbitol.
I would like to know what other facilities do, what resources are out there to help these moms during pregnancy and after, besides dhs taking the baby or whatever.
Does anyone do drug screens on all their moms? We have only one nurse that has worked elsewhere who says where she worked on the east coast, everyone got screened.
Your help would be appreciated.
Feb 16, '10
To address the original post and questions (and not debate drug screening): Our OBs screen everyone when beginning care, no matter who they are or what their situation. They are told this both verbally and in writing when they start their OB care, so no one is "singled out" or surprised. Those coming back + get counseled about drug use and how it affects their fetus and also referred for treatment as appropriate. We also have similar protocols to what Elvish described, when they enter our care in the hospital. It's true, people you would NEVER suspect of using do, you can't tell by looking at them or judging their histories. Having a clear protocol in place and using it consistently will protect you best in cases of doubt on who to screen. Anyone coming back positive or with a history of drug use, automatically we have to test their babies.
I also agree the much larger issue is getting appropriate and prompt treatment for withdrawing babies. This is not for small or inexperienced nurseries but for larger facilities with experience in this area. Withdrawal in and of itself can be dangerous and even deadly if baby is in care of inexperienced staff. MUCH larger and important is the issue of knowing which babies are affected and how to treat them. Referral to a facility where this is done is best.
I would be working on a protocol on whom to screen and what is to be done for babies withdrawing from substances ASAP. You would not want a baby to experience undue complications due to not knowing of them or inexperience in dealing with them. I work in such a smaller community hospital that transfers such babies out to higher Level facilities that have neonatal abstinence programs and staff who know how to treat them. The posts before mine are excellent and offer insight into what you should do when you suspect drug use or babies withdrawing from such substances.
Last edit by SmilingBluEyes on Feb 16, '10