drug screens on admission???

SmilingBluEyes · Mar 21, 2006

well said Marla. And I think being strictly punitive is not the answer, either.

Campnurse123 · Mar 21, 2006

I am glad that you are on my side - I think no one is to be excluded. That is what we are planning on doing - (per our CNM yesterday) . Our hospital talked with the hospital we transfer to (we are only a Level 1 nursery) and they screen EVERYONE!! Just the other day we had a "soccer mom" test positive for THC - baby's urine was negetive - but the drug screen on the stool was postive for THC. FYI - drug screening a newborn's mec will show what the baby was exposed to for approx 15-20 weeks prior to birth. If any of our mom's test positive or have a hsitory - it is an automatic urine & mec screen on baby. Our CNM says we'll be focusing on treatment not punishment.

Have a great day & GOD BLESS

SmilingBluEyes · Mar 21, 2006

WOOT!!! LOVE it!

RNnL&D · Mar 25, 2006

We don't do routine drug screens on admission. They are done for pts presenting with no prenatal care, positive history of drug use, placental abruptions, and sometimes, preterm labor.

Personally, I don't think they should be routinely done on all pts. But then, I'm one of those flaming liberals who believes in patient's rights.

Really, if you think about it, yes, a pos tox screen might alter treatment of the newborn, but so would a pos HIV result, and that's not required. At least, not in Ohio.

HappyNurse2005, RN · Mar 25, 2006

They (our OB's) plan to do one with the patient's routine first labs & then tell them to expect one when they present in labor.

But, if a mom is a user, and knows she'll be tested, there's a chance she might not come in to hospital for care when its needed, for fear of being caught doing drugs.

If we are going to drug test them, I'd say do it uniformly, and don't tell them you're going to do it. Get an honest picture.

And why do you need a mom's permission? I'm not an OB nurse, I'm a cardiac nurse. We can drug test ppl with out asking them permission first.

RainDreamer, BSN, RN · Mar 25, 2006

The policy at my last hospital was they would do a UDS on the mom if she had NO prenatal care (1 visit or less). If that was the case, we would also do a mec. drug screen on the newborn.

They would also do a drug screen if mom was an abruption.

Those are the 2 cases in which they automatically, always did a drug screen. I'm not sure if they got permission from the mother (I didn't work L&D, I just worked in the nursery), but we never got permission for the mec. drug screen.

SmilingBluEyes · Mar 25, 2006

It's not either-or here.

You don't have to be against patient rights to advocate for drug screens-----at least then, you what you may be dealing with in a newborn.

Some people are addicted to and/or use meds that can cause some serious complications in newborns, as far as 24-48 hours after delivery, or more. I think from a safety standpoint, it's a good thing for us to know these things ahead of time! Like I said, it need NOT be punitive.

Had a gal while back who was a chronic user of percoset/vicodin ---not your stereotypical "drug user type" (if there is one). Well 2 days after delivery baby seized, despite all precautions. It was a darn good thing we knew about this and the baby was taken to the appropriate NICU, after birth, where they could manage this. Had we not known it could have been different. That is why I think screens are wise for all patients. You have a baby's wellbeing, not just a mom's rights, to be concerned with here.

RainDreamer, BSN, RN · Mar 25, 2006

It's not either-or here.
You don't have to be against patient rights to advocate for drug screens-----at least then, you what you may be dealing with in a newborn.
Some people are addicted to and/or use meds that can cause some serious complications in newborns, as far as 24-48 hours after delivery, or more. I think from a safety standpoint, it's a good thing for us to know these things ahead of time! Like I said, it need NOT be punitive.
Had a gal while back who was a chronic user of percoset/vicodin ---not your stereotypical "drug user type" (if there is one). Well 2 days after delivery baby seized, despite all precautions. It was a darn good thing we knew about this and the baby was taken to the appropriate NICU, after birth, where they could manage this. Had we not known it could have been different. That is why I think screens are wise for all patients. You have a baby's wellbeing, not just a mom's rights, to be concerned with here.

Excellent points.

We would also do MDSs on babies if they had unexplained jitteriness. Like you said, these babies would seize despite all precautions, and we never knew about a drug history (because it's not routinely done). These babes would come to the regular NBN. It's scary.

RNnL&D · Mar 25, 2006

I'm not sure if they got permission from the mother (I didn't work L&D, I just worked in the nursery), but we never got permission for the mec. drug screen.

We don't get permission for a drug screen either, which may be part of the reason I don't think it should be done routinely. It just seems sneaky and deceptive. I suppose if it was part of the admission labs, and the pt was aware, it would be different. You know....... "we are drawing blood for a blood type, CBC, and we need a urine sample for a drug test. We do them routinely on everyone."

fergus51 · Mar 25, 2006

I don't know if its worth it to do it routinely for people with no risk factors.

RainDreamer, BSN, RN · Mar 25, 2006

We don't get permission for a drug screen either, which may be part of the reason I don't think it should be done routinely. It just seems sneaky and deceptive. I suppose if it was part of the admission labs, and the pt was aware, it would be different. You know....... "we are drawing blood for a blood type, CBC, and we need a urine sample for a drug test. We do them routinely on everyone."

I see where you're coming from, it'd make sense just to tell the mom that, that it's routine so they don't feel like they're singled out.

I think it'd be hard though to have to get mom's permission for an MDS. A lot of times if they suspect they are going to test the baby, they will throw the diapers out. Then there goes our chance of getting the mec. So we usually just get the MDS if the baby has a mec diaper while in the nursery, or we just tell the mom's to keep the diapers because we need to keep track of all the pees and poops.

RNnL&D · Mar 25, 2006

I don't know if its worth it to do it routinely for people with no risk factors.

There's also the cost factor to consider. I don't know how much a drug screen is, but since most insurance carriers pay a standard reimbursement rate for a vag delivery, I wonder who would eat the cost.