Implementing a clinical checklist for pregnant patients with opioid use disorder

BACKGROUND

Opioid use disorder (OUD) has been increasing in pregnant patients over the past two decades. Best practice guidelines that are available for these patients, must now be implemented by health care teams. Clinical checklists have been used for other complex patient cohorts with good success and are a potentially viable tool for ensuring best practices with this patient population as well.

LOCAL PROBLEM

Maine has seen a dramatic increase in the number of pregnant patients with OUD. Many of these patients seemed to "fall through the cracks" in the traditional prenatal care model. The obstetrical care team expressed feeling overwhelmed by the complex care needs of these patients and unsure of how to improve their care.

METHODS

To improve prenatal care delivery for patients with OUD, we implemented an evidence-based clinical checklist. This local, NP-led quality improvement project was done in partnership with a state-led initiative to improve perinatal care for patients with OUD.

INTERVENTIONS

An evidence-based checklist provided by the state initiative was implemented for prenatal patients with diagnosed OUD.

RESULTS

Use of a clinical checklist for patients with OUD increased the rate of several best practices during their prenatal care, including emergency naloxone prescription, tracking prescription monitoring reports, and contraceptive planning. Rates of completed prenatal screening for substance misuse, social determinants of health, and intimate partner violence also increased in our practice overall, as a result of this project.

CONCLUSIONS

To further improve perinatal care coordination for patients with OUD, we recommend future evaluation of clinical checklists within various practice settings.

Reproductive endocrinology and infertility nurse online orientation program evaluation: a quality improvement initiative

Objective

To evaluate the effectiveness of a novel online orientation program (Nurses in REI Communication, Knowledge, and Skills [NRCKS]) among new and early-career reproductive endocrinology nurses to make recommendations for program quality improvement.

Design

Quality improvement.

Subjects

Reproductive endocrinology nurses.

Exposure

Online orientation program featuring 8 micromodules.

Main Outcome Measures

Knowledge acquisition, confidence, user experience, skills, and abilities.

Results

Nurses demonstrated a statistically significant increase in reproductive knowledge after completion of NRCKS. Most nurse users felt confident applying knowledge in the clinical settings after program completion. Nurse users had an overall positive experience with interactive components and quality of visuals. Most nurse users gained skills and abilities that they will implement into professional practice. Nurses suggested improving navigation, adding more visuals in content expert presentations, and teaching soft skills necessary for the role of reproductive endocrinology nurses.

Conclusions

Nurses in REI Communication, Knowledge, and Skills was well received by nurse participants and emphasized the receptivity and desire for reproductive health and fertility training among novice reproductive endocrinology nurses. Nurses in REI Communication, Knowledge, and Skills increased nursing knowledge, and nurses felt confident applying newly gained knowledge in the clinical setting on completion. Nurse participants provided invaluable feedback for quality improvement to inform the hard launch. The results emphasize the online orientation's strong potential to close the theory-practice gap.