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Reducing Maternal Mortality In Opioid-Addicted Mothers Essay Paper

Reducing Maternal Mortality In Opioid-Addicted Mothers Essay Paper

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Hi, welcome to my presentation of the evidence-based practice project proposal to reduce maternal mortality in opioid-addicted mothers. In the presentation, I discuss the problem, the PICOT question, organizational change readiness, implementation, and evaluation.

Opioid addiction among pregnant women is a significant issue in the United States and globally (Center for Drug Evaluation and Research, 2019). Studies have shown high maternal mortality rates among opioid-addicted mothers compared with non-drug-dependent pregnant women. Bruzelius and Martins (2022) reported that between 2017 and 2022 death rates among opioid-addicted pregnant women rose by 81% and 38% in women without OUD. Opioid-addicted mothers are also likely to have poor maternal outcomes and risk their children’s health. High mortality rates in drug-dependent women are associated with a lack of access to comprehensive services (Rizk et al., 2019). Inadequate support also increases the risk of death in this group (Petersen et al., 2019). Provision of maternity plus substance use treatment and support can enhance the health of opioid-addicted mothers and their children (Goodman et al., 2020)Reducing Maternal Mortality In Opioid-Addicted Mothers Essay Paper.

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The proposed evidence-based practice (EBP) project aims to examine if, a comprehensive care package leads to decreased mortality rates in opioid-addicted mothers compared with routine care. The project targets the population of opioid-addicted women in the antepartum, intrapartum, and postpartum phases in a small community hospital. The EBP project seeks to answer the following PICOT question: “In pregnant women who are opioid addicted (P), does providing a comprehensive set of services delivered in a coordinated and integrated approach (I) compared to opioid-addicted pregnant women receiving standard care (C) lead to a decrease in maternal deaths in ante/intrapartum/and postpartum patients (O) from day 43-365 days (T)?” Reducing Maternal Mortality In Opioid-Addicted Mothers Essay Paper

The organization where I will implement the evidence-based practice project is a small community hospital. Its mission is to create an environment where individuals obtain accessible and affordable services to restore health and general well-being. The hospital commits to disease prevention and health promotion. It also aims to ensure care accessibility to all its clients since it serves a medically underserved area.  Opioid-related deaths among pregnant women are also at a high rate in the hospital. The organization also embodies accountability, acceptance, respect, diversity and inclusion, teamwork, and collaboration. The organizational culture provides a foundation for the implementation of an intervention to address the high maternal mortality rates.

An assessment for readiness for change indicated the community hospital is prepared to implement the proposed EBP intervention. It was completed using the Organizational Readiness for Change Assessment (ORCA). ORCA is a 74-item tool that evaluates an organization’s preparedness for change (Crittendon et al., 2020)Reducing Maternal Mortality In Opioid-Addicted Mothers Essay Paper. The ORCA survey indicated that the hospital recognizes opioid-related maternal mortality as a problem. The community hospital is also committed to disease prevention and health promotion. Besides, its culture of teamwork and collaboration also supports the implementation of EBP interventions, such as comprehensive care for opioid-addicted mothers. Furthermore, the management is supportive. Nonetheless, the organization requires enhancing readiness to implement the EBP project proposal.

A few strategies can be implemented to improve the organizational readiness for change. One is staff training to enhance competence in implementing the intervention. The healthcare staff in the community staff requires knowledge of the proposed comprehensive set of care services for opioid-addicted mothers, including how to evaluate outcomes. The other strategy is change management for stakeholders through communication. The project will affect several stakeholders, including patients, physicians, specialists (obstetricians), nurses, and the hospital management. The project leader should use various communication channels to communicate purpose, urgency, and priority. They should also gather and provide feedback. Another strategy is conducting a feasibility study to illustrate the relevance of the project to the hospital board (Vax et al., 2021). A procedural policy detailing the recommended intervention, the target population, and when, and how to implement is also crucial. Lastly, the organization should provide the required resources, including healthcare information and communication technology to facilitate patient education and follow-up (Raynor et al., 2023)Reducing Maternal Mortality In Opioid-Addicted Mothers Essay Paper.

Opioid-related mortality is high among opioid-addicted pregnant women compared with non-drug-dependent women (Bruzelius & Martins, 2022). Lack of comprehensive care, comprising maternity care and substance use treatment increases mortality risk in this group (Rizk et al., 2019). Inadequate social support and provider follow-up also lead to poor maternal and child health outcomes. Addicted pregnant women are also likely to lack family support or access to healthcare providers (Petersen et al., 2019). Comprehensive care from antepartum to postpartum periods can reduce addiction and reduce mortality. It should involve antenatal, maternity, and postnatal care and substance use treatment. (Goodman et al., 2020)Reducing Maternal Mortality In Opioid-Addicted Mothers Essay Paper.

Comprehensive care programs for pregnant women with OUD address access barriers and improve client recovery and resilience. Before pregnancy, women with OUD may not access mental healthcare services for their addiction (Goodman et al., 2022). Community hospitals in the U. S. increasingly provide specialized SUD care for pregnant and postpartum women (PPW). There is a realization of the significance of integrating substance use care in clinical services for pregnant women with opioid addiction (Meinhofer et al., 2020). A comprehensive care package includes screening, brief intervention, and referral for treatment (Rizk et al., 2019).  Other interventions are pharmacotherapy to control addiction with buprenorphine, collaborative and integrated care, and harm reduction principles to reduce overdose deaths (Mazel et al., 2023). Also, education is delivered through supportive techniques (motivational interviewing) technology (Parlier-Ahmad et al., 2023). Outcomes of comprehensive care are reduced addiction, improved mother and child health, and better care for children born with opioid withdrawal syndrome (Singleton et al., 2022)Reducing Maternal Mortality In Opioid-Addicted Mothers Essay Paper.

The selected model for this EBP project is the social-ecological model. The model enables healthcare providers to have a holistic perspective on health. It addresses several factors affecting health. It has been applied in implementing interventions for mental health (Agency for Toxic Substances and Disease Registry, 2023). The model has four circles as in the diagram on the slide, representing the four multilevel factors: individual, relationship, community, and societal.  The model will enable the project team to implement interventions that will achieve the primary outcome, reduced maternal mortality among opioid-addicted pregnant women. The individual-level interventions will manage opioid addiction and maintain the women’s health. They include pharmacotherapy, behavioral therapy, routine antepartum, intrapartum, and postpartum. Care for neonates with opioid withdrawal syndrome is also included in the package (Hoyland et al., 2022). The relationship-level strategies seek to engage spouses/partners and family in care for mothers with OUD to ensure they have adequate social support. The community-level interventions aim to form partnerships for managing opioid use disorders.  The last level has interventions targeted to healthcare disparities and social determinants of health that limit certain groups from getting OUD care (Rizk et al., 2019)Reducing Maternal Mortality In Opioid-Addicted Mothers Essay Paper.

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Setting

The project will be implemented in a small community hospital. The facility has been recording increased maternal mortality rates among opioid-addicted mothers. There is no substance use disorder (SUD) care for women with addiction. The current project will provide a comprehensive set of services to pregnant women attending antenatal clinics. Informed consent of the individuals and site authorization will be sought before implementing the intervention.

Timeline

The evidence-based practice project will take 365 years. The project team will track women from postpartum day to 365th day. Staff training on interventions the participants will receive will be completed before implementation. The intervention will be provided in three periods: the antepartum before delivery, intrapartum childbirth, and post-partum-post-delivery. Data on participation and outcomes will be collected to inform the evaluation of outcomes, which will be conducted quarterly and at the project end. Reducing Maternal Mortality In Opioid-Addicted Mothers Essay Paper

The intervention will be delivered in three stages. Pregnant women attending prenatal care at the community hospital will be screened for OUD. Those identified with opioid addiction will be referred to the treatment center in the hospital for pharmacotherapy and behavioral counseling. A care team will also be convened based on the patient’s needs. During labor and childbirth, the women will receive supportive services, including pediatric care for their newborns. In the postpartum phase (day of discharge to 365 days), the participants will get long-term care and maintenance, including weekly appointments with the care team (rehab therapist, social worker, and counselor) and peer support groups. These interventions will ensure holistic health for participants and their children (Jalali et al., 2020)Reducing Maternal Mortality In Opioid-Addicted Mothers Essay Paper. The staff will be trained in implementing and evaluating comprehensive packages to improve expected outcomes.

Budget and Resource List

The intervention will require some resources for effective implementation. The staff training will be conducted by an external staff trainer who has certification in comprehensive care for pregnant women with substance use disorder. The trainer will cost $5500. They will be a temporary hire for the staff training. Staff training materials and facilitation will cost the hospital $6400. It is estimated that the interventions will cost $125000. This figure was arrived at after multiplying the estimated cost of treating one patient with OUD ($2500) and 50 participants. The figure could be more or less depending on the number of participants.  The other expense for the project is monitoring and evaluation. After every 90 days (quarterly), the project team will evaluate the project and report results. Likewise, after the implementation, the team will conduct the final evaluation. The process will cost $10000. The project will also need personnel. However, there will be no need to hire. Overall, the proposal is feasible because it will reduce the mortality rates, a patient safety issue, with cost, ethical, and legal implications at $146900 (Rizk et al., 2019)Reducing Maternal Mortality In Opioid-Addicted Mothers Essay Paper.

The proposed project has the following stakeholders. Pregnant patients with OUD will receive the intervention. The healthcare providers who will undertake the screening, brief intervention, and referral. The mental health counselors will provide behavioral therapies. The social workers are also critical players as they help the healthcare team address the social determinants of health. The law enforcement are other interested parties, but they will not be involved directly to enhance the participation rate. The project team will be drawn from these stakeholders to improve the outcomes.

Barriers & Solutions

A few barriers may impede this project’s implementation. The patients may decline to participate in the study due to concerns about legal enforcement. The project leader will address this challenge by assuring the participants that the program is for health promotion. Financial constraints could also derail the intervention. The project team leader will collaborate with the community hospital management to secure funds for sustaining the program. The project’s length could discourage some participants from completing it. The care team will follow up on patients to ensure adherence.

The EBP’s project primary outcome is a decrease in maternal mortality among opioid-addicted mothers who will be participating in the intervention. The project team will also track secondary outcomes, including participation and completion rates, engagement/satisfaction, and neonatal abstinence syndrome (NAS) cases. The evaluation will be conducted using a semi-structured questionnaire to be filled in by the participants. The questionnaire was selected because it can collect data from a large sample (Taherdoost, 2021). The data collected will be analyzed using nonparametric tests: Chi-square test and linear regression analysis. The two tests are best suited for analyzing data from semi-structured questionnaires, particularly that of a qualitative nature (Shreffler & Huecker, 2021)Reducing Maternal Mortality In Opioid-Addicted Mothers Essay Paper.

The questionnaire will gather data from the participants and the care team on primary and secondary outcomes. It will have sections and questions targeted to the healthcare providers and the patients.  After data collection, it will be analyzed using the non-parametric tests. The results will inform further actions. For instance, an investigation of the project process will be initiated if it fails to produce positive results. The expected primary outcome is a reduction in maternal mortality in participants of the proposed EBP intervention.  No changes or an increase in the death rate will indicate ineffectiveness. After the implementation, the project team may decide to discontinue, extend, revise, or maintain the program in the community hospital.

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Pregnant women with opioid addiction are at an increased risk of maternal mortality. Providing comprehensive care that combines routine ante-, intra-, and post-partum care and substance use disorder treatment can control opioid addiction and associated deaths. The current evidence-based project will implement a comprehensive care package for women in three phases: before delivery, labor and childbirth, and postpartum. Implementation will be done in the community hospital in 365 days. Evaluation will be conducted quarterly to determine the primary outcome, maternal mortality, and secondary outcomes. The evaluation results will determine if the project will be maintained, discontinued, or revised and extended. Reducing Maternal Mortality In Opioid-Addicted Mothers Essay Paper

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