drug testing AP and IP

Specialties Ob/Gyn

Published

Our facility has been talking about doing drug tests on all of the OB patients. Either one time in the office (if neg) and then follow up if it is positive.

It is already in our new OB packets that we may do a random drug screen at any time during the pregnancy. Our referral center states they test all laboring women, but we can not get a written policy from them.

There has been an explosion of meth and crack labs and use in our rural area . We don't want to miss something staring us in the face.

There has been an increase in TTN and RDS babies lately and we have not been able to pin point a source.

If anyone has a policy for drug screening their patients, could you please send a copy to me. I really need to get something going to either prove or disprove the theory.

Any suggestions??

Thanks,

Vicki

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.

I agree. How 'bout the married woman whose spouse cheats on her? Or the woman whose had an STD since high school? No correlation to risky behavior there. I am assuming ALL pts, not just OB get drug tested, if not then this too is very discriminatory.

I don't know ,I can understand how heartbreaking it must be to see babies suffer b/c of their drug abusing mothers, but it could get very legally and ethically murky very quickly. How 'bout the woman who doesn't know she's pg until 12 + weeks. If FL is talking about taking babies away from 'enadngering' parents, where do you draw the line? What if Mom has more than 2 cups of coffee/ day? Or a glass of wine? Seems like a slippery slope to me. JMHO.

Jen

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and our NNP order drug screens if there is any history of STD's.

Wow! This NNP must never think outside the box. Ever come across a married woman who's husband steps out on her come into the office with an STD? How is this type of mother guilty of risky behavior? I totally agree with MJLRN97, this smacks of discrimination and should be stopped or the NNP should find other parameters in which to catagorize the drug testing. It should be done across the board or not at all. :nono:

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That was the point of trying to get a protocol started. It would be for all patients. I never cease to be amazed at the people who turn up positive. The RDS would be for everyone at least once during the pregnancy. I will have to see what research I can find.

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Specializes in Babies, peds, pain management.

Our policy currently is to do a UDS if a woman comes to triage with no prenatal care or if the nurse "suspects" drug usage. Recently, a girl (teenager) came to triage in preterm labor (35 wks) and 4 cms.

She "looked and acted" unusual. (Missing teeth-genetic disorder, marks on her face-acne, and alittle out-of-control-in labor, first baby, scared). She had had prenatal care (and a neg drug screen from the OB's office). But the nurse did a UDS, without her knowledge or permission, based on the nurse's suspicion. It came back positive for cocaine. Mother swears somebody must have slipped it to her. Baby also tested +. Social Services is called and it is a mess. The baby had no s/s of cocaine addiction (ate and slept well). Mom and family were very appropriate and willing to do whatever was asked of them. Except for the + UDS you would have never know there were drugs used at all. The nb was placed in a foster home until a court hearing. I am not condoning the use of illegal drugs but this girl was treated like she was scum. Yes, she was positive but the test would not have been done but for a nurse's suspicion and was done without her knowledge or consent. What I guess I'm trying to say is, do it on everybody or following a strict set of guidelines (no prenatal care) but not just because she looks a certain way. I don't know how it all ended but I hope the baby went back to the grandparents if not the mother.

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Specializes in Long Term Care.

The people who do not believe that drugs cause problems with the fetus/infant need their heads examined.

I have witnessed with my own eyes what happens when Moms use during pregnancy. It isn't fair to the child. Forget the money that society ends up paying for the child's care. Forget about the resources that could be used elsewhere.

Think about this instead.

What about the children who will never learn to speak, read or write? Never crawl, walk, run or dance? Never have a first crush, kiss, or date? Never hold a job, never fall in love, get married or have kids of their own? Never be able to go outside and hike in a National Park or participate in a town parade? What about the child? What about THAT human being who IS innocent?

Don't they deserve to be thought of and protected too?

edited for spelling

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The people who do not believe that drugs cause problems with the fetus/infant need their heads examined.

I have witnessed with my own eyes what happens when Moms use during pregnancy. It isn't fair to the child. Forget the money that society ends up paying for the child's care. Forget about the resources that could be used elsewhere.

Think about this instead.

What about the children who will never learn to speak, read or write? Never crawl, walk, run or dance? Never have a first crush, kiss, or date? Never hold a job, never fall in love, get married or have kids of their own? Never be able to go outside and hike in a National Park or participate in a town parade? What about the child? What about THAT human being who IS innocent?

Don't they deserve to be thought of and protected too?

edited for spelling

The mandatory testing will prevent very few cases. People who are addicted to drugs can rationalize ANYTHING. Most moms who use will just not get PNC because of the drug testing. I think once word gets out that everyone is tested, then we will have more pts without prenatal care.

I have seen drug testing done because a poor mom admitted to doing marijuana years ago. Mom and baby were negative. She was on welfare, so we better test her!! Then we had this primip who was a RN, admitted to occasional cocaine use. Since she was middleclass and admitted to it there was no order for testing and baby went home with mom. If that is not discrimination, I don't know what is.

BTW I agree that drug use is wrong and should NEVER occur during pregnancy. I feel that it is unfair for the infants to suffer. However, I do not believe mandatory drug testing is the answer.

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Specializes in Pediatrics.

This topic surely strikes a cord with me. In Florida I went into preterm labor with my daughter. Spontaneously, and even after the terb and mag my uterus continued to contract regularly. My husband was a manager of a nationwide company and had just been transferred from Atlanta, GA. Our insurance went from Kaiser to Blue Cross, but our cards hadn't arrived yet. I recall the nurse coming into the room and handing me paperwork to fill out for emergency Medicaid. I told them I did not need Medicaid, I had insurance. She would not believe me. She sent in a social worker to "talk" to me. I was married, young, and BLACK. I had never sampled drugs, I didn't have multiple sex partners, and my family income was above average. My husband kept insisting we had insurance but I was told I needed to fill out the paperwork or I couldn't be treated. ??? At this point I was in the basement triage. I wasn't offered a meal, I was treated very coldly.

When my husband finally got in contact with the insurance company and got proof of insurance I was moved to the labor suite. I was offered smoothies, and my ten month old was given ice cream and cookies. It was a totally different environment. The change was surreal. But what really burned me was about a month after my daughter's birth I received an itemized bill from my insurance company. Associated lab fees included blood and urine tests, and associated tests for newborn. Upon further investigation I came to find out these tests were not PKU and the like, they were for illegal narcotics!

I don't have a problem with drug testing OB patients across the board, but I don't think this particular hospital tested across the board. Just like my "level of service" changed from when I was an emergency Medicaid recipient to a full fledged insurance carrying patron, I feel my young age, assumed economic status, and race played a large part in why I was drug tested.

It's not even being stereotyped that bothers me. But because of such random testing, my hospital bills are higher than say, the upper middle class Caucasian woman in her low thirties. It's a financial injustice as well.

What also bothered me, and may even border on illegal, is that I did not sign a consent for the test on me or my child. If one has to sign consents for HIV testing, routine newborn screenings, and inoculations, why would it be acceptable to drug test a woman without consent?

I feel that if it was because I was in PTL that I and my child were drug tested, then it should have been discussed with me. It was all very secretive, and if it weren't for my bill, I would have never known that I had been drug tested. That doesn't seem right to me at all. Policies about PTL and drug/alcohol testing make sense. However, if these policies exist they should not only be routine, but they should be discussed with the patient or the patient advocate if the patient is unable to comprehend the explanations. This is all opinion, though.

I don't want to ruffle feathers or get flamed. This is my personal experience with random drug testing. As a rule, I am all for drug testing OB patients. If we can save the lives of children born to drug and alcohol addicted mothers then we are doing these children a great service. However, if we are picky and choosy about whom we screen, based on what we see (or don't see for that matter) then we are doing many children who are born to addict mothers a disservice...all because the mothers don't fit the stereotypical "addict" mold and squeak by under the radar.

I wish you the best of luck with your policy writing. Rock on! Let's institute hospital wide protocols so that some young mother doesn't have to endure the type of pain and embarrassment I personally experienced.

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