Procedure for drug screens?

[nurseob7]

I'd appreciate finding out how your unit handles drug screens. Our unit is requesting a urine speciman on every inpatient OB pt and we are told to send it to lab to be held. This way if a doctor orders a urine drug screen on the pt within the next week, it is available.

Does this seem acceptable? I called another hospital today and they said they only collect urine on a pt if they have an order for it and then the staff that handles the urine needs to sign a chain of command. Urine needs to be walked to the lab. They told me you should just hold a urine in lab without documentation.

Please tell me what your unit does? Thank you

[SmilingBluEyes]

Unfortunately our policy lacks. We collect UDS on only "high risk" patients, e.g. no prenatal care, sketchy history, behavioral issues, etc. I think ALL should be screened or none at all. That is the most fair way and no one can scream "discrimination" or challenge us if we did that way.

One more thought: I would be darn sure you have a dr order before ordering UDS on anyone; CYA. Or it may come back to "bite" you.

[Jolie, BSN]

Given the potential implications of a (+) drug screen (DCFS or Social Services involvement) I agree that it is important to have established policies regarding the collection, handling, reporting, and verification of drug screen results. But, in my experience, this has not been the case. I have never personally handed a specimen to the lab personnel, nor have I ever signed a document establishing a "chain of responsibility" for one. I think that would be required in criminal cases, but I've never dealt with urine drug screens on a criminal basis.

The practice of collecting a urine specimen and having the lab hold it "in case" a drug screen is ordered later does not sound right to me. There is no way to verify the "security" of a specimen that sits in a lab refrigerator for a week.

[gr8rnpjt, RN]

I am sorry, but I have a real problem with routinely ordering drug screens on Ob patients.

Case in point, my daughter was sick from early in her pregnancy right through to delivery. She had severe nausea and vomiting all day long. She was in the ER numerous times, and was admitted once in her second trimester for pancreatitis, brought on by stress, continuous vomiting, not able to keep anything down, etc. After all these visits to er and a couple of inpt admissions for the pancreatitis and hyperemesis, on a routine visit, she had a urine drug screen.

When the results came back, I was not with her but her OB treated her very suspiciously due to her drug screen coming back + for opiates. Now with all these er visits and admissions, she was given several narcotics including morphine, dilaudid, demerol, fentanyl, etc. I don't know how long these things stay in her system but she had been given demerol just 3 days prior during an ER visit. They treated her like a criminal, when these are the doctors who had been giving her all these narcotics. She mentioned that and the doctor said we didn't give you heroin! What? Aren't they all derived from opiates?

They acted like the meds they gave her do not show up on the drug screen just illegal drugs!. Now, if the OB's are going to test her for drugs, then I think they should be more educated on what the tests mean, and that pain meds they order will come up as an opiate. Am I right?

[SmilingBluEyes]

If a person is positive for opiates, all one need do is look at her medical history....if there is a legit Rx for them in her hx, then no problem. Moms are often given small amts of morphine, for example, for therapeutic rest in my unit when they are in painful but prodromal labor. If they were to come up positive, it would be easy enough to check out what was going on and go from there.

Personally, I find that picking and choosing whom should be tested suspect and very wrong, as well as just distasteful. There are drug-using soccer moms, too, not just the "usual suspects" (such as homeless, poor or people lacking prenatal care). Fair is fair; test them all or not is best to me, and then no one can scream we are being discriminatory and threaten to sue. And yes, chain of custody, HUGE ISSUE....collecting and holding is a HORRIBLE practice. We are talking about people's lives here, moms and babies.

Funny enough, you might be surprised at what people ARE using what substances. Of course, then what has to be decided is what to DO about that----and that is a whole other thread and can of big worms.

[Mermaid4]

AS far as my last place of work, we were at liberty to collect urine on people we considered "at risk". However, a random screen of a lawyer's wife that turned out positive rapidly resulted in a policy change that involved both consent and an order. Now we can ask the doc and get an order, which is a good thing except there are some pedi's who don't want their patients drug histories revealed in case Dss is to get involved. That would seem to be a moot case, however, since hospital policy dictates anyone with a history of substance abuse who does or does not consent to an odu (drug test), will have their newborn automatically bagged. Anyone refusing that or removing the bag from the baby is an automatic social service consult, and would have been anyway. I agree with the getting an order for a test especially with what occurred at our facility. It involved the lawyer's wife and the hospital lost even though she was positive on the basis that there was no consent or order obtained...