Purpose for the program: Recent literature reviews state that approximately 5-10% of women self-report the use of illicit drugs during pregnancy and universal testing in high-risk populations’ results in increased rates versus self reporting alone. Facilities should establish their own testing protocols and unbiased guidelines to identify when testing should occur as the literature does not indicate consensus on universal screening. A positive maternal result determines the initiation of the protocol to test newborns.

Proposed change: Meconium drug screening is considered the gold standard for drug testing in the neonate but, due to false positive screens, the length of time to obtain confirmatory results it was identified that a practice change was necessary. Due to the sensitive nature of this testing accuracy in patient results are crucial. Increases in false positive results lead to questioning the truthfulness of the test. Identification of a process that provided ease of obtaining specimen sampling and accurate patient results was the goal. The proposed change was to implement umbilical cord tissue screening. The advantages of this process included samples being sent immediately after birth, receiving only confirmatory results and a chain of custody. Due to the sensitive nature of drug testing and possible legal ramifications a chain of custody was seen as necessary piece of our process improvement.

Implementation, outcomes and evaluation: The plan was discussed with Neonatologists and Pediatricians both were in favor. Nursing leadership met with Pathology and Lab Directors to discuss switching testing from a local laboratory and sending to an outside reference lab.  Initial implementation began at a regional tertiary care facility and a smaller community hospital where the largest volumes of maternal substance abuse were experienced. The outcomes focused on increasing result turn around times, potentially decreasing newborn’s length of stay and decreasing rates of false positives.

Implications for nursing practice: Included the need for a standardized order set for newborns experiencing neonatal abstinence symptoms which was developed in collaboration between Nursing and Neonatology. All nursing staff received in-service on neonatal abstinence scoring of the newborn to help provide more consistency and accuracy of scores among staff.  

Keywords: drug testing, substance abuse, umbilical cord testing, neonatal abstinence scoring