MOMS Plu lus Project October Action Period Call Ohio Perinatal - - PowerPoint PPT Presentation

Through collaborative use of improvement science methods, reduce preterm births & improve perinatal and preterm

newborn outcomes in Ohio as quickly as possible.

MOMS Plu lus Project

October Action Period Call

Ohio Perinatal Quality Collaborative

October 18, 2019

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Welcome

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Housekeeping: Participant Code

➢ PLEASE BE CERTAIN TO USE YOUR PARTICIPANT CODE!! ➢#participant code#

This call will now be recorded

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Housekeeping: Chat box

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Please add your name and organization to the chat box: (e.g.) Susan Ford, OPQC

Today’s Presenters

Today’s Facilitators Project Management Team

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Mona Prasad, DO, MPH OhioHealth Grant/ OPQC Faculty Mentor Susan Ford, MSN OPQC QIC Rachel Staley, MPA OPQC Project Specialist Cole Jackson, MS OPQC Project Specialist

Agenda

Time Topic Presenter

12:00 pm Welcome & Agenda Review Susan Ford, MSN, RN 12:05 pm Data Review Susan Ford 12:15 pm The Challenging Pregnant Patient with OUD

• Cleveland Clinic
• Adena Regional Medical Center
• Zepf Center

Mona Prasad, DO, MPH Jennifer Ayala, RN Donna Collier-Stepp, LISW-S Bobbi Constantinoff, LPN, CDCA All Teach ~ All Learn Team sharing regarding the case scenarios All participants 12:50 pm Next steps/Wrap up Susan Ford

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SMART Aim Key Drivers Interventions

By January 31, 2020 we will: Optimize maternity medical home to improve outcomes for pregnant women with opioid use disorder (OUD) as measured by:

• Increased identification of

pregnant women with OUD

• Increased % of women with OUD

during pregnancy who receive prenatal care (PNC), Medication Assisted Treatment (MAT) and Behavioral Health (BH) counseling each month

• Decreased % of full-term infants

with Neonatal Abstinence Syndrome (NAS) requiring pharmacological treatment

• Increased % of babies who go

home with mother

Project Leader: Carole Lannon (PI)

Optimize the health and well-being of pregnant women with opioid use disorder and their infants

Global Aim

Pregnant women with

• pioid use disorder

Population

Revision Date: 8/30/2019

MOMS+ Project Key Driver Diagram (KDD)

Compassionate care/ culture change Identification of pregnant women with OUD Supportive care and tracking during pregnancy Connection to postpartum support

• Provide training in trauma informed care and addiction as chronic disease

for clinical practitioners

• Ongoing support for practice culture change
• Identify a care coordinator to provide ongoing support and assist with

referrals and ongoing communication among the multi-disciplinary care team.

• Use tracking system to monitor care of pregnant women with OUD

diagnosis (e.g.. Database, spreadsheet)

• Use standardized checklist for maternity care of the pregnant patient with

OUD

• Coordinate care among OB, BH, MAT, care navigator by regularly

reviewing shared patients (e.g. multi-disciplinary care conference, huddle).

• Tailor counseling and support for healthy behaviors based on patient-

specific situation/need during pregnancy (sobriety, smoking cessation, stable housing and future contraception plan) with referral to community resources as needed to augment medical resources.

• Selection and use of a standardized screening tool for all OB patients to

identify pregnant women with OUD (e.g. 5 P’s, NIDA Quick Screen).

• At time of identification, assess need to prevent acute opiate withdrawal

by initiating or referring to MAT

• Establish connections for coordinated referral to maternity care from BH

and MAT providers, drug courts, prisons, homeless shelters, and ERs.

• Ensure mom and baby have a Patient Centered Medical Home (post-

delivery)

• Provide a warm handoff to pediatric care provider for infant post discharge
• Provide lactation consultation (if applicable), post partum depression

screening and contraceptive counseling; and ”normalization” of postpartum transition (overwhelmed)

• Facilitate continuation of OUD treatment and services post-delivery occur
• Coordinate with Department of Job & Family Services/Child Protective

Services regarding reporting requirements and infant plan of safe care

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Jennifer Ayala

Cleveland Clinic – Hillcrest & Fairview Hospitals

The challenging pregnant patient with OUD

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The patient who is in and out of treatment throughout her pregnancy

• “Cindy” is a 22-year-old, G1 patient
• Drug use started around age 16 after she had surgery for gallstones

and was prescribed Percocet

• Addiction progressed to "snorting" pills/heroin and then further to IV

drug use

• Used throughout the pregnancy despite going in and out of treatment
• Came to L&D actively using

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All Teach ~ All Learn

To submit a question to the presenters, type your question or comments into the CHAT box and hit send.

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Donna Collier-Stepp

Adena Regional Medical Center

The challenging pregnant patient with OUD

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Polling Question #1

• At our site, the following % of women with OUD smoke

during their pregnancy:

• 90 – 100%
• 89 - 75%
• 74 – 60%
• 59 – 45%
• 44 – 30%
• Less than 29%

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• Number of women who have participated

in group – 228

• Number of women who use tobacco - 214

94%

The patient with OUD who continues to smoke during pregnancy

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Strategies Used

• Education on effects to fetus (including several

handouts)

• Education on complicating withdrawal for baby
• Speaker from Ohio Department of Health
• Speaker from “Baby and Me Tobacco Free”
• Tobacco Cessation Program with incentives

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Outcomes

• 0.4 % quit (1 woman did quit)
• Less than 5% (9 women) reported LESS use
• The majority 94% (218 women) reported SAME or

INCREASED use due to stress

• Suggestions?

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All Teach ~ All Learn

To submit a question to the presenters, type your question or comments into the CHAT box and hit send.

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Bobbi Constantinoff

The Zepf Clinic

The challenging pregnant patient with OUD

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Continued use of illicit substances while on MAT during pregnancy

• “Jane” is a 32-year-old, G5P4
• She entered treatment during second trimester of

pregnancy

• DOC: heroin and cocaine
• Prescribed Buprenorphine
• Had not established prenatal care prior to admission
• Planning to place baby for adoption

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Challenges

• Continued use of heroin and cocaine throughout

pregnancy, refused higher level of care

• Attempting to keep client engaged in services while

actively using

• “meet her where she’s at”
• Individualized care
• Involve entire treatment team, including adoption

counselor

• Developed post-partum care plan

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All Teach ~ All Learn

To submit a question to the presenters, type your question or comments into the CHAT box and hit send.

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Resources from OHA…

Next steps

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Teams:

• The next MOMS+ Action Period Call will be Friday,

November 15th at 12N Suggested PDSA: Test one of the strategies discussed during the case scenario presentations. Key Contacts: Review/submit Monthly Progress Report; the October MPR will be sent out Wednesday 10/30/19

It takes a village…

The MOMS Plus project is funded by the Medicaid Technical Assistance and Policy Program (MEDTAPP) and administered by the Ohio Colleges of Medicine Government Resource

• Center. The views expressed in this meeting are solely those of the authors and do not represent the views of state or federal Medicaid programs.