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

MOMS Plu lus Project October Action Period Call Ohio Perinatal Quality Collaborative October 18, 2019 Through collaborative use of improvement science methods, reduce preterm births & improve perinatal and preterm newborn outcomes in Ohio as quickly as possible.

Welcome Please be certain you are on “mute” when not speaking to avoid background noise. Whether you have joined by phone or computer audio, you can mute and unmute yourself by clicking on the microphone icon The following shortcuts can also be used For PC: Alt + A : Mute or Unmute For Mac: Shift + Command + A: Mute or Unmute For telephone: *6 : Mute or Unmute 3

Housekeeping: Participant Code ➢ PLEASE BE CERTAIN TO USE YOUR PARTICIPANT CODE!! ➢ #participant code# This call will now be recorded 4

Housekeeping: Chat box Please add your name and organization to the chat box: (e.g.) Susan Ford, OPQC 5

Today’s Presenters Today’s Facilitators Project Management Team Rachel Staley, MPA Cole Jackson, MS Mona Prasad, DO, MPH Susan Ford, MSN OPQC Project Specialist OPQC Project Specialist OhioHealth Grant/ OPQC QIC OPQC Faculty Mentor 6

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 Mona Prasad, DO, MPH • Cleveland Clinic Jennifer Ayala, RN • Adena Regional Medical Center Donna Collier-Stepp, LISW-S • Zepf Center Bobbi Constantinoff, LPN, CDCA All Teach ~ All Learn All participants Team sharing regarding the case scenarios 12:50 pm Next steps/Wrap up Susan Ford 7

MOMS+ Project Key Driver Diagram (KDD) Revision Date: 8/30/2019 Project Leader: Carole Lannon (PI) Interventions Global Aim Key Drivers • Provide training in trauma informed care and addiction as chronic disease Optimize the health and well-being of Compassionate care/ for clinical practitioners pregnant women with opioid use culture change • Ongoing support for practice culture change disorder and their infants SMART Aim • 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). By January 31, 2020 we will: • At time of identification, assess need to prevent acute opiate withdrawal Optimize maternity medical home to Identification of by initiating or referring to MAT improve outcomes for pregnant pregnant women • Establish connections for coordinated referral to maternity care from BH women with opioid use disorder with OUD and MAT providers, drug courts, prisons, homeless shelters, and ERs. (OUD) as measured by : • Identify a care coordinator to provide ongoing support and assist with • Increased identification of referrals and ongoing communication among the multi-disciplinary care pregnant women with OUD team. • Use tracking system to monitor care of pregnant women with OUD • Increased % of women with OUD diagnosis (e.g.. Database, spreadsheet) during pregnancy who receive Supportive care • Use standardized checklist for maternity care of the pregnant patient with prenatal care (PNC), Medication and tracking during OUD Assisted Treatment (MAT) and pregnancy • Coordinate care among OB, BH, MAT, care navigator by regularly Behavioral Health (BH) reviewing shared patients (e.g. multi-disciplinary care conference, huddle). counseling each month • Tailor counseling and support for healthy behaviors based on patient- specific situation/need during pregnancy (sobriety, smoking cessation, • Decreased % of full-term infants stable housing and future contraception plan) with referral to community with Neonatal Abstinence resources as needed to augment medical resources. Syndrome (NAS) requiring pharmacological treatment • Ensure mom and baby have a Patient Centered Medical Home (post- delivery) • Increased % of babies who go • Provide a warm handoff to pediatric care provider for infant post discharge home with mother • Connection to Provide lactation consultation (if applicable), post partum depression screening and contraceptive counseling; and ”normalization” of postpartum support Population postpartum transition (overwhelmed) • Facilitate continuation of OUD treatment and services post-delivery occur Pregnant women with • Coordinate with Department of Job & Family Services/Child Protective opioid use disorder 8 Services regarding reporting requirements and infant plan of safe care

The challenging pregnant patient with OUD Jennifer Ayala Cleveland Clinic – Hillcrest & Fairview Hospitals 15

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 16

All Teach ~ All Learn To submit a question to the presenters, type your question or comments into the CHAT box and hit send. 17

The challenging pregnant patient with OUD Donna Collier-Stepp Adena Regional Medical Center 18

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% 19

The patient with OUD who continues to smoke during pregnancy • Number of women who have participated in group – 228 • Number of women who use tobacco - 214 94% 21

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 22

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? 23

All Teach ~ All Learn To submit a question to the presenters, type your question or comments into the CHAT box and hit send. 24

The challenging pregnant patient with OUD Bobbi Constantinoff The Zepf Clinic 25

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 26

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 27

All Teach ~ All Learn To submit a question to the presenters, type your question or comments into the CHAT box and hit send. 28

Resources from OHA…

Next steps Teams: - The next MOMS+ Action Period Call will be Friday, November 15 th 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 30

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.