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PA PQC OUD Survey
By October 29, please work with your team to complete this survey for the period of April through September 2019.
1.
What is your health system name?
2.
Which site/hospital within your health system are you submitting data for?
3.
What is your name?
4.
Does your site currently have a process in place to provide ongoing OUD sensitivity training requirements for staff and providers?
Yes
No
5.
If you entered yes for question 4, which staff receive education? (Check all that apply)
Physicians
Nurses
Other clinical support staff
Administrative support staff
There is not a process in place to educate staff on substance use
6.
If you entered yes for question 4, please describe the education:
In-Person
Web-Based
Available for CME credits
Other (please specify)
7.
If you entered yes for question 4, is staff education on substance use in pregnancy mandatory or volunteer?
Mandatory
Volunteer
8.
Does your site have standardized materials for educating women with OUD, regarding OUD and in pregnancy and mother’s role in NAS newborn care (i.e. pediatric consult, patient education materials)?
Yes
No
9.
If you entered yes for question 8, what patient education material is your health system providing to patients?
Institution-developed material
NIDA
SAMHSA
ASAM
ACOG
CDC
Other (please specify)
10.
Does your site use a validated, self-report screening tool for substance use in pregnancy?
Yes
No
11.
If you entered yes for question 10, which self-report screening tool is your health system using to screen pregnant women for OUD? (You may choose more than one answer. If your health system does not screen pregnant women for OUD, choose "none.")
The 4 P's / The 4 P's Plus
The 5 P's
Institution Developed Tool
DAST-10
NIDA Quick Screen
SURP-P
ASSIST
Hospital Screening Questionnaire (HSQ)
None
Other (please specify)
12.
If you entered yes for question 10, which patients receive self-reported screening?
Universal; we screen all pregnant women
Risk-based; we only screen select pregnant women
Varies by provider; we do not have institutional guidance regarding screening
13.
If you entered yes for question 10, when do patients receive self-reported screening? (Check all that apply)
First prenatal appointment
At prenatal appointments when substance use is supsected
Delivery
Varies by provider
Other (please specify)
14.
Does your site use urine toxicology to identify substance use during pregnancy?
Yes
No
15.
If you entered yes for question 14, how would you describe your urine toxicology screening process?
Universal; we screen all pregnant women
Risk-based; we only screen select pregnant women
Varies by provider; we do not have institutional guidance regarding screening
16.
If you entered yes for question 14, when do patients receive urine toxicology screening? (Check all that apply)
First prenatal appointment
Delivery
Varies by provider
Other (please specify)
17.
Does your site provide opioid pharmacotherapy for pregnant women with OUD?
Yes
No
18.
If you entered yes for question 17, which pharmacotherapy services does your site provide? (Check all that apply)
Subutex
Suboxone
Methadone
Detoxification
Other (please specify)
19.
Has your site developed referral relationships with any OUD treatment programs in your area/county?
Yes
No
20.
Does your site provide behavioral health services for pregnant women with OUD?
Yes
No
21.
If you entered yes for question 20, which services? (Check all that apply)
Mental health counseling
Drug and alcohol counseling
Psychiatry
Other (please specify)
22.
If you entered yes for question 20, who provides the services? (Check all that apply)
Psychiatry
Social services/social work
Primary care providers/family medicine
Obstetrics/prenatal providers
Other (please specify)
23.
Has your site developed unique clinical pathways/order sets for pregnant women with OUD?
Yes
No
24.
If you entered yes for question 23, which pathways (Check all that apply)?
Prenatal Care
Intrapartum Care
Postpartum pain control
Postpartum care
Other (please specify)
25.
If you entered yes for question 23, do clinical pathways include screening all pregnant women with OUD for additional co-morbidities?
Yes
No
26.
If you entered yes for question 25, which comorbidities?
HIV
HCV
Psychiatric comorbidities
Intimate Partner Violence (IPV)
Pregnancy intention
Other (please specify)
27.
Is a “Plan of Safe Care” developed for all pregnant women with OUD prior to hospital discharge?
Yes
No
28.
If you entered yes for question 27, which care team develops this plan? (Check all that apply)
Social services/social work
Obstetricians/prenatal providers
Nursing
Other (please specify)
29.
Does your site provide immediate postpartum contraceptive counselling and services?
Yes
No
30.
If you entered yes for question 29, which contraceptive methods are provided in the immediate postpartum period? (Check all that apply)
Nexplanon
IUD
Oral contraceptives/vaginal ring/patch/injection
Tubal ligation
Other (please specify)