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PQCNC 2023 ClOUDi Continuation 2.0

The clOUDi project aims to improve care for mothers with substance use disorder and their newborns through a statewide initiative. It focuses on screening mothers for substance use, providing education and treatment support, and standardizing care for newborns at risk for neonatal abstinence syndrome. The goals are to screen all pregnant women, provide brief interventions and treatment referrals for those screening positive, and deliver optimal care for newborns through family-centered care and plans of safe care.

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kcochran
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688 views12 pages

PQCNC 2023 ClOUDi Continuation 2.0

The clOUDi project aims to improve care for mothers with substance use disorder and their newborns through a statewide initiative. It focuses on screening mothers for substance use, providing education and treatment support, and standardizing care for newborns at risk for neonatal abstinence syndrome. The goals are to screen all pregnant women, provide brief interventions and treatment referrals for those screening positive, and deliver optimal care for newborns through family-centered care and plans of safe care.

Uploaded by

kcochran
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Comprehensively Lessening Opioid Use

Impact for Moms and Babies


(clOUDi):
A statewide project to improve the care of
mothers with substance use disorder and
their newborns
clOUDi Continuation
• Allow sufficient time for completion/sustainment of current goals
• Extend validated verbal screening in hospitals and out patient clinics
• Expand ESC care in hospital settings with moms not morphine the preferred
medicine for babies with neonatal opiate withdrawal syndrome
• Capitalize on evolving innovations in EMRs
• Enhanced Collaboration with NC MATTERS, NC Substance Abuse Services
Division of DHHS, and NC DPH Perinatal Nurse Champions
• Reconvene expert team to examine
• Integrate screening for maternal depression and mental health concerns
• Incorporation of increased use of breast milk
• Incorporation of Safe Sleep
• Revised Data collection
1

1CDC 2018
clOUDi
Comprehensively Lessening
Opioid Use Disorder Impact
• 150 strong expert team meeting over 9 months, 22 web meetings, to
develop the current inpatient aim statement, action plan, metrics and key
driver diagram
• AIM project using AIM bundle “Obstetric Care for Women with Opioid Use
Disorder” as guideline
• Minimum two year project involving maternal / newborn providers
working with PQITS (Perinatal Quality Improvement Teams) both
outpatient and inpatient
• Provide the best evidenced care for mothers and babies affected by opioid
use disorder in the antepartum, peripartum and postpartum period
clOUDi Mission
• For Moms
• Provide the facilitation, support, and education necessary to identify mothers
and deliver optimal care for opioid use disorder during and after a pregnancy

• For Babies
• Provide the facilitation, support and education necessary to partner with
mothers (and families) to deliver optimal care for infants at risk for neonatal
abstinence syndrome (NAS) in the hospital and for the first six months post
delivery
clOUDi Aims
• For Moms
• SBIRT (Screen, Brief Intervention, Referral for Treatment)
• Equitable and evidence (validated) based verbal screening for opioid use disorder in
pregnant women during the antepartum and intrapartum periods. (S)
• Build care environments where providers are comfortable delivering non-judgmental,
supportive brief intervention (BI) assessment and where accepted timely referral to
treatment (RT)
• Reduce stigma and bias associated with maternal disclosure of any substance
use
• Reduce impediments to clinical care after disclosure
Between 1999 and 2014, the prevalence of opioid use disorder during pregnancy increased from 1.5 to 6.5 per 1,000 hospital births per year

clOUDi Inpatient
(Comprehensively Lessening Opioid Use Disorder Impact)
January 2021

For Moms - decrease complications of OUD in pregnancy by optimizing the care for women
through screening, education, resource mapping, access to treatment services, and
protocols for all stages of pregnancy including postpartum care in all locations where care is
received
Year 1:
• 100% of pregnant women screened at any prenatal visit and on entry to the hospital for delivery
Year 2:
• 100% of positive screens receive a brief intervention
• 75% of women receptive to a referral for treatment are assessed and evaluated for treatment
• 100% of women receive prenatal education regarding the risk for and treatment of neonatal abstinence
syndrome
• 75% of women accept plan of safe care and continue treatment
clOUDi Date Schedule Inpatient Measures for
Moms
• In January 2021, August 2021 and January 2022
• 100% of women delivering screened on entry to the hospital for delivery for
substance use using a validated verbal screening tool
• Did positive mothers receive a referral and were they evaluated
• Did women screening positive receive prenatal education regarding the risk
for and treatment of neonatal abstinence syndrome
• All other months
• Same measures but only for screen positive mothers
• Reduce data burden and allow teams to focus on areas requiring intervention

https://www.pqcnc.org/node/14023
clOUDi Aims
• For Babies
• Providing a standardized approach to the identification, evaluation,
treatment, discharge and follow up of the NAS infant.
• Standardize the non-pharmacologic and pharmacologic care of the NAS infant
• Increase partnership and supports offered mothers, guardians and family
members after discharge from the hospital
From 2008 to 2014, the rate of NAS/NOWS increased from 1.8 cases per 1,000 hospital births to 8.2 cases per 1,000 hospital births.

clOUDi
(Comprehensively Lessening Opioid Use Disorder Impact)
January 2021

For Babies - provide the facilitation, support and education necessary to deliver optimal
care for infants evaluated for neonatal abstinence syndrome (NAS) in the hospital and for
the first six months of the newborn period
Year 1 includes
• Multidisciplinary hospital and community-based team focused on providing a standardized approach to the
identification, evaluation, treatment, discharge and follow up of the NAS infant
• Expert Team recommendation that centers move to ESC care for NAS infants
• Partner with moms and families to be part of the care of NAS
• 25% reduction in length of stay for NAS infants
• 100% of NAS infants and their families will be offered the opportunity to participate in a Plan of Safe Care

https://www.ncdhhs.gov/divisions/mental-health-developmental-disabilities-and-substance-abuse/infant-plan-safe-care
clOUDi Measures Postnatally
• Plan of safe care accepted
• Maternal treatment status
• Readmissions
• Unexpected ER visits
• Well child visit schedule maintained
• Developmental follow up of infants seen in developmental clinics

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