O3233: Reducing Neonatal Toxicology Screens by Standardizing the Definition of Inadequate Prenatal Care

Purpose/Objectives: Perinatal toxicology screens are frequently ordered for pregnant women with inadequate prenatal care (PNC). These screens are often among the most overused, and misinterpreted tests during hospitalization for childbirth. However, there exists a lack of consensus among healthcare providers and nurses regarding the definition of inadequate prenatal care. Standardizing these definitions across departments can help decrease the number of unnecessary toxicology tests.

Objective:
To decrease the number of neonatal toxicology screens by 5%
by standardizing the definition of inadequate PNC over a 6-month period from August 2023 to February 2024(cycle 1)

Design/Methods: The project used the Plan-Do-Study-Act (PDSA) framework as part of the Model for Improvement.

PDSA Cycle 1 (August 2023 - February 2024):
A multidisciplinary team agreed to use the modified Kessner Index (figure 3) to define inadequate prenatal care (PNC) due to its simplicity and ease of understanding for staff.
Reviewed and analyzed baseline toxicology test results.
Developed a Key Driver Diagram (image 1) to clarify the new standardized definition of inadequate PNC using the Kessner Index and to promote awareness of its aim to reduce toxicology screenings.
Estimated the monthly number of toxicology screenings sent.
Calculated the percentage of monthly toxicology screenings sent relative to total live births.
Used a statistical process control chart (image 2) to monitor the outcome measure's monthly progress.
Estimated the number of neonates readmitted with withdrawal symptoms as a balancing measure.
PDSA Cycle 2 (March 2024 - September 2024):
Revised the criteria for toxicology screening by excluding isolated marijuana use.

Results: Our baseline data showed a mean neonatal toxicology screening rate of 17%. After implementing the first PDSA cycle, the rate dropped to 13% due to standardizing the definition of inadequate prenatal care, resulting in a 4% decrease. All data points after this intervention were below the previous mean, indicating a shift.
In the second PDSA cycle, we adjusted the criteria for toxicology screening by excluding isolated marijuana use. This led to a significant decrease in the percentage of total toxicology screens sent, dropping to 4%—a 13% decrease from baseline. With only one data point from the second cycle, it is too early to draw definitive conclusions about the newer process change, though data collection is ongoing.. There were 0 readmissions for neonates readmitted with withdrawal.

Conclusion/Discussion: The standardization of the inadequate PNC definition through the utilization of the Kessner Index resulted in a decrease in the percentage of neonatal toxicology screens. This outcome is expected to lead to reductions in unnecessary costs, resource utilization, and associated stigma.