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PQCNC AIM clOUDi Prenatal Pilot Snapshot

Page One

This question requires a valid date format of MM/DD/YYYY.
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**Questions #7-15 refer to verbal or written substance use disorder screening**
7. Approximately what percentage of your prenatal patients are screened for substance use disorder (SUD) using a verbal or written screening tool at any time during their pregnancy?   *This question is required.
Substance use disorder screening tools that have been validated for use in pregnancy include: 
  • NIDA Quick Screen
  • Integrated 5 Ps Screening Tool
  • Substance Use Risk Profile Pregnancy Scale 
  • 4 Ps Plus
  • Community Care of North Carolina (CCNC) Pregnancy Home Risk Screening Form 
Does your clinic utilize a standardized, validated verbal or written SUD screening tool?  *This question is required.
Does your clinic have a standard protocol to guide providers if a patient has a positive verbal or written SUD screen? *This question is required.
Does the protocol include discussing the results of the positive SUD screen with the mother? *This question is required.
Does the protocol include providing patient education on neonatal abstinence syndrome? *This question is required.
Does the protocol include patient education about the care provided to newborns with neonatal abstinence syndrome at the hospital of delivery? *This question is required.
The following questions refer to Urine Drug Screening
8. Approximately what percentage of your prenatal patients receive a urine drug screen at any time during their pregnancy? *This question is required.
Is patient consent obtained specifically for the urine drug screen, beyond the general consent to care? *This question is required.
Approximately what percentage of your prenatal patients have a positive urine drug screen at any time during their pregnancy? *This question is required.
The following questions refer to Your Clinic
9. Does your clinic have a social worker or case manager on-site?  *This question is required.
10. Does your clinic have an electronic patient medical record system that directly communicates with a hospital system?  *This question is required.
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