Create a flow chart and/or checklist of care steps for antenatal care of women with opioid use disorder (OUD). Refer to the example below and an additional example in the Resources section of this Best Practice.
Why we are recommending this best practice
A checklist will help providers remember the many steps involved in the antenatal care of women and families with OUD. While these services and activities would normally be addressed over the course of prenatal care, they may need to be compressed depending on when the woman presents for care. Referenced are examples from the Illinois Perinatal Quality Care Collaborative and the Northern New England Perinatal Quality Improvement Network.
Strategies for implementation
Collaborate with health care team members to adapt a written checklist that is specific for your site of care.
Checklists come in many forms: some for use in emergencies, some for use prior to surgery, and some simply as reminders for the supermarket. A prenatal checklist serves both as an ongoing set of reminders and as documentation of important tasks completed. A checklist, such as the one above, is central to the care of a complex patient with many external consultations over a long period of time, and a pregnant woman with substance use disorder is one of the most challenging to care for. A provider must navigate special laws and unfamiliar regulations, co-manage with other key providers, order different panels of blood tests, approach building communication and developing trust differently, and provide education on topics not usually covered in prenatal care. Examples of the latter include special plans for labor pain management, preparation for neonatal substance withdrawal, and most important of all, developing a Plan of Safe Care (POSC) for both the baby and mother.
The Prenatal Checklist provides the central direction for the team’s actions in antenatal care. It belongs front and center in the prenatal record and should be reviewed at every visit by providers, staff, and the patient. This toolkit provides several examples. Through small tests of change, modifications can be made to the example checklists until it meets the needs of patients at the care site. Follow up at the postpartum visit should include questions about what the patient thinks could be improved—no checklist is ever a final product!