In-hospital screening and assessment

Santa Clara County, California
Perinatal Substance Abuse Protocol

• In- Hospital Screening and Assessment including In-Hospital Substance Abuse Screening Checklist for Maternity Patients

When to use

On all patients admitted for labor and delivery (including emergency room admissions).

1. Obtain and review results from supplemental Prenatal Screening Health Questionnaire and any assessment.
2. Perform In-Hospital Substance Abuse Checklist on all patients (View pdf file here) (May be performed by a health care provider)
3. Obtain order for infant and maternal Toxicology Screen if indicated by:
   • History of substance abuse alcohol and/or drug use during pregnancy
   • Alcohol and/or drug use during this pregnancy
   • No (Or limited) Prenatal care
   • Placental abruption, prematurity, or SGA, stillborn, or neonatal death
   • Symptoms of use or withdrawal (mother or newborn)
4. Negative
   • In-Hospital Screening Checklist and Toxicology Screen (if done) provide routine care
5. Positive (continue on)
   • In-Hospital Screening Checklist for Toxicology Screen perform Substance Abuse Assessment (preferably to be done by Medical Social Worker)
     • Assessment is high risk refer to:
       1. Department of Family and Children's services and/or Public Health Nurse/ Home Health Agency
       2. Treatment/support/community services. as indicated
     • Assessment is medium risk refer to:
       1. Public Health Nurse/Home Health Agency
       2. Treatment/support/community services, as needed
     • Assessment is low risk:
       1. Provide routine care