Process Map for SBIRT at Initial OB Visite process
Transcript of Process Map for SBIRT at Initial OB Visite process
Screening for substance use during pregnancy using an SBIRT framework
Gratefully reproduced with permission from Northern New England Perinatal Quality Improvement Network http://www.nnepqin.org/a-toolkit-for-the-perinatal-care-of-women-with-opioid-use-disorders/
reviewed: 5/8/2018
Patient instructed by to complete electronic
screening tool on tablet / laptop
Support staff leaves clinic room during electronic
screening
Patient takes brief
screen
Support staff uploads result in electronic
medical record
Electronic screening tool automatically
administers full screen
Screen negative
AUDIT ≥ substantial level and/or DAST ≥ moderate level
AUDIT moderate level and/or DAST low level
Process Map for SBIRT at Initial OB VisiteprocessduDuri General orientation to
practice, includes substance use policy
At one point during visit, staff ensures patient is
seen privately for confidential screening
Support staff leaves clinic room during electronic
screening
Patient arrives for initial prenatal visit
Prenatal visit with provider begins, BI
and RT are not indicated
Substance use screening
questionnaire
Patient takes brief
screen
Warm handoff to provider
Screen negative
Patient completes
screen
Electronic screening tool automatically
administers full screen
Warm handoff to provider
Screen positive
Follow up questionsBI by provider
Referral to behavioral health
for counseling
Routine prenatal care; education;
encourage abstinence
Occasional use only
Substance use
severity
Referral to addiction provider for further
evaluation and treatment
Moderate to Severe Substance Use
Disorder Suspected
Low to Moderate Substance Use
Suspected
BI=Brief intervention RT= Referral to treatment
Screening for substance use during pregnancy using an SBIRT framework
Gratefully reproduced with permission from Northern New England Perinatal Quality Improvement Network http://www.nnepqin.org/a-toolkit-for-the-perinatal-care-of-women-with-opioid-use-disorders/
reviewed: 5/8/2018
II. SBIRT Process: SCREENING
All pregnant women should be screened using a validated instrument.
• All pregnant women should be informed about the health system’s policy on prenatal drug,tobacco, and alcohol use at the first prenatal encounter, as part of their orientation to thepractice (see example patient letter)
• Screening for substance use should be conducted while a woman is alone or accompanied onlyby young children
• Creating space for confidential screening allows providers to ask questions about other sensitivetopics such as their reproductive health history, and to safely screen women for domesticviolence
• If a woman cannot be confidentially screened, screening should be deferred
• Timing of screening• Screening should be done at initiation of prenatal care, and repeated in the third
trimester• Screening should also be repeated on admission for delivery
• A number of substance use screening tools have been validated for use during pregnancy. Thebest tool is the one which is easy to use in a given context
• A positive screen does not equate to a diagnose a substance use disorder, but rather to theneed for further exploration about risk of substance exposure during pregnancy