At ACLS Academy, we are committed to promoting excellence in healthcare education, and we are excited to highlight a significant contribution from one of our esteemed instructors. Recently, Instructor Kristine DiCarlo co-authored a study on a quality improvement project on implementing a Perinatal Substance Use Screening Protocol in the Outpatient Setting published in Science Direct. This quality improvement project addresses a critical gap in clinical practice, aligning with the strong recommendations from leading organizations such as the American College of Obstetricians and Gynecologists (ACOG), the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), the Massachusetts Department of Public Health (MDPH), and the World Health Organization (WHO). Despite the endorsement of universal screening for substance use during pregnancy, its practical integration through the SBIRT (Screening, Brief Intervention, and Referral to Treatment) process remains a challenge, and DiCarlo's work aims to bridge this important gap in care.

The Study - Perinatal Substance Use Screening Protocol in the Outpatient Setting 

Specific Aim: The purpose of this quality improvement project was to implement the 5Ps Screen for Alcohol/Substance Use tool and the SBIRT process into clinical practice. In addition, this project sought to determine if enhanced training regarding the screening tool and the SBIRT process would improve perinatal care providers’ adherence with universal substance use screening in clinical practice. To evaluate clinical adherence, a retrospective chart review was conducted to assess screening rates before and after.

Context: The setting included three community-based, outpatient obstetrics and gynecology clinics that offer prenatal care in southeastern Massachusetts. Thirty-one perinatal care providers, including obstetricians, certified nurse-midwives, nurse practitioners, physician assistants, nurses, medical assistants, and office staff, who provide prenatal care for more than 1,000 pregnant women annually across the three prenatal clinics participated in this quality improvement project.

Interventions/Measurements: Training consisted of two phases that reviewed the SBIRT process, the 5Ps screening tool, brief intervention conversations, and the process for referral to treatment. Pre- and postimplementation screening rates were compared and analyzed using descriptive statistics and chi-square tests of independence.

Results: Preimplementation screening rates were 14.4%. Screening rates measured 1 month after implementation were 44.6% (p < .001). Universal screening was not achieved.

Conclusion: Short-term improvement in screening for perinatal substance use was observed. Whether these results are sustainable beyond the project time frame is unknown. Future work should examine longer-term outcomes and continued barriers to universal uptake of the screening protocol.

About Co-Author Kristine DiCarlo

Kristine DiCarlo, DNP, RN, NPD-BC, RNC-MNN, C-EFM, is a Clinical Professional Development Specialist at South Shore Health in South Weymouth, MA. She has over 20 years of experience as a maternity nurse. Kristine is Board Certified in Nursing Professional Development and Certified in Maternal Newborn Nursing. She obtained her Master’s Degree in Nursing Education in 2017 and recently received her Doctorate in Nursing Practice from Aspen University. She has been teaching NRP and AHWONN’s Fetal Heart Monitoring courses for over 10 years including courses at ACLS Academy.

Kristine became interested in a maternity nursing specialty after utilizing a midwife for the birth of her daughters. The personalized, supportive relationship she had with her midwife during all phases of her pregnancy, birth, and postpartum period was so impactful and piqued her desire to support and care for other women in the same way.

In her role as a Nurse Educator for the NICU and Special Care Nursery at South Shore Hospital, Kristine enjoys the opportunity to advance the nursing practice in her unit while still having the ability to be at the bedside.  While she no longer takes patient assignments, she is ready to jump in and help out when needed.  

In addition to her recent quality improvement project on the Implementation of a Perinatal Substance Use Screening Protocol in the Outpatient Setting, Kristine also co-authored a study in 2018 about the Barriers to and Interventions that Increase Nurses' and Parents' Compliance With Safe Sleep Recommendations for Preterm Infants.

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