drug testing AP and IP

babyktchr, BSN, RN · May 27, 2006

I think it is a fabulous idea, and our facility is trying to do the same thing. I just haven't had enough time to research it at this moment in my life. I know Michelle Murray spoke of drug testing at one of her conferences and I don't remember what she said about it, and I have to dig out that syllabus to locate some reading on the subject.

We recently had a mom who denied drug use, and then had a potentially life threatening reaction when she got a dose of nubain. Low and behold, she then admitted to "taking a bite" of a methadone pill from time to time. Of course she tested positive for the methadone. Had we drug tested her, we woulda known. Our OB offices test if there is admitted history, and our NNP order drug screens if there is any history of STD's. We also test for any r/o PTL.

I am hoping someone has something to share!!!!

weirdRN, RN · May 27, 2006

I think drug testing at the begining of pregnancy for everyone would be a good idea. and include it as a routine screen along with the regular urine, strep b, stds and other screenings we do. We justify all of those as for the health of the mother and fetus. This would be no different

I know the majority will be negative, and those that are positive can be followed up on. That brings to mind a legal issue though.

I heard and I can't rmember the source that the state of Florida is trying to take children from their parents and send the parents to jail for endangerment of a child and child abuse when they use/abuse drugs during their preganancy. I am not sure what the criteria is for this but, I could see this opening a can of legal worms.

KellNY, RN · May 27, 2006

Our OB offices test if there is admitted history, and our NNP order drug screens if there is any history of STD's.

Could you explain the rational of that practice?

babyktchr, BSN, RN · May 28, 2006

Could you explain the rational of that practice?

I have no rationale other than this NNP just came to us from "the big city" and she correlates STD's with drug use. At least that is how she explained herself to me.

Long Term Care Columnist / Guide · May 28, 2006

I have no rationale other than this NNP just came to us from "the big city" and she correlates STD's with drug use. At least that is how she explained herself to me.

That's pretty discriminatory. Big city or not, she could find herself the target of a lawsuit if a patient were to be arrested, go to jail or lose her child as a result of a drug test that was performed on her and not, say, on a patient who DOESN'T have an STD.

Inconsistencies like this smack of classism, racism, and just about every other 'ism' I can think of. If I were still working OB, or even if I were still having babies myself, I wouldn't object to routine drug screens.....but only as long as they are as "routine" for upper-income married white women as they are for single moms on welfare (with or without STDs).

And that's all I have to say about THAT.

babyktchr, BSN, RN · May 28, 2006

That's pretty discriminatory. Big city or not, she could find herself the target of a lawsuit if a patient were to be arrested, go to jail or lose her child as a result of a drug test that was performed on her and not, say, on a patient who DOESN'T have an STD.
Inconsistencies like this smack of classism, racism, and just about every other 'ism' I can think of. If I were still working OB, or even if I were still having babies myself, I wouldn't object to routine drug screens.....but only as long as they are as "routine" for upper-income married white women as they are for single moms on welfare (with or without STDs).
And that's all I have to say about THAT.

Just for the sake of saying this....I didn't say I agreed with said NNP.:chair:

kids · May 28, 2006

A history of STDs can can be in indicator of risk taking behavior.

In my area it is protocol for all patients of the state funded maternity clinic to be tested several times during the pregnancy. I've actually seen the patient info form that says that "failure to comply" may result in a CPS referral. The clinic's standing admission orders for their patients include a UDS, failure to comply or a + test at that point is reported to CPS.

My experience with the two large private practices is that testing is only done for a reported drug use during the current pregnancy, suspected current drug use and upon admission for PTL/PROM.

Long Term Care Columnist / Guide · May 28, 2006

Just for the sake of saying this....I didn't say I agreed with said NNP.:chair:

I know you didn't. Sorry if it sounded like I was jumping on you........I didn't mean it that way at all.:chair:

My problem is with ANY sort of drug testing that is done essentially on the basis of stereotypes, e.g. single mom=history of risky behaviors=suspicion of drug use, or Medicaid recipient=poverty=suspicion of drug use.

When my grandson was born, I was working on the OB floor at the hospital, so I knew both he and my daughter were tested, and to this day I'm sure it was done because she was poor, unmarried, and had no health insurance. She also has NO illicit drug history whatsoever, has been with only one man in her entire life, doesn't smoke or drink, and took excellent care of herself during her pregnancy. Nonetheless she was stuck with the bill for urine AND blood tests.

In the meantime, neither her better-off, married roommate with Blue Cross nor the roommate's infant, whom I took care of during that same time, was ever tested for any drugs. Now, would someone like to explain to me how that is NOT discrimination?

Now, to be frank, I think drug screening ought to be no different from any other aspect of prenatal care: just a routine part of pregnancy, like blood-glucose testing, urinalysis, and ultrasound. It's when you get into selecting which moms will have the testing, and threatening them with referrals to CPS if they don't comply, that it becomes a tool for controlling people's behaviors rather than promoting healthful habits, and that is far more likely to drive women away from prenatal care than encourage them to seek it. And that, IMHO, is defeating the purpose of doing it in the first place, which is to prevent harm and ensure the best possible environment for fetal growth.

weirdRN, RN · May 28, 2006

Now, to be frank, I think drug screening ought to be no different from any other aspect of prenatal care: just a routine part of pregnancy, like blood-glucose testing, urinalysis, and ultrasound. It's when you get into selecting which moms will have the testing, and threatening them with referrals to CPS if they don't comply, that it becomes a tool for controlling people's behaviors rather than promoting healthful habits, and that is far more likely to drive women away from prenatal care than encourage them to seek it. And that, IMHO, is defeating the purpose of doing it in the first place, which is to prevent harm and ensure the best possible environment for fetal growth.

:yeahthat:

weirdRN, RN · May 28, 2006

It is my OPINION that when you become pregnant you are taking responsibility for another life.

It is my OPINION that you can do what ever you please with your own body and to heck with it.

It is my OPINION that NO ONE should be allowed to harm themselves when they become pregnant if they choose to carry the pregnancy to term.

All of that is just my opinion. And it doesn't count for squat.

mommy2boys · May 28, 2006

I think that drug testing for the mother and infant should be manditory. My OB always tests all of him mothers w/ their first blood work up. I had to sign a form saying that I would allow him to test for drugs and HIV. I was a white middle class woman who was married. My friend also used him as an OB and she was tested. She was single and on state insurance.

I have a problem when they only test "high risk" mothers. I know of a few situations when a person is upper middle class married mother that use drugs. And many low income people that never have used drugs.

I fell that as long as you test every woman and infant that enters the hospital regardless of insurance or income, there shouldn't be a problem. Good luck writting a policy for your hospital. I think that it is a very good idea and could help out a patient who doesn't want to admit to a drug problem.

JMO

Erin