Decline of the Gold Standard! Umbilical Cord Tissue Provides Timely and Accurate Results to Enhance Quality Outcomes for the Neonate


Poster Presentation

Purpose for the Program

Recent literature reviews stated that approximately 5% to 10% of women self-report the use of illicit drugs during pregnancy; however, universal testing in high-risk populations indicates higher rates of illicit drug use. Facilities should establish their own testing protocols and unbiased guidelines to identify when testing should occur because the literature does not indicate consensus on universal screening. A positive maternal test result determines the initiation of the protocol to test newborns.

Proposed Change

Meconium drug screening is considered the gold standard for drug testing in the neonate, but because of false positive test results and the length of time to obtain confirmatory results it was identified that a practice change was necessary. Because of the sensitive nature of this test, accuracy in patient test results is crucial. Increase in false positive test results lead to questioning the truthfulness of the test. The goal was to identify a process that provided ease of obtaining specimen sampling and accurate patient test results. The proposed change was to implement umbilical cord tissue screening. The advantages of this process included samples being sent immediately after birth, receiving only confirmatory results, and a chain of custody. Because of the sensitive nature of drug testing and possible legal ramifications, a chain of custody was seen as a necessary piece of our process improvement.

Implementation, Outcomes, and Evaluation

The plan was discussed and approved by the neonatologists and pediatricians. Nursing leadership met with pathology and lab directors to discuss switching the testing location from a local laboratory to sending the tests to an outside reference lab. Initial implementation began at a regional tertiary care facility and a smaller community hospital where the largest volumes of maternal substance abuse were experienced. The outcomes focused on increasing result turnaround times, potentially decreasing the newborn's length of stay, and decreasing rates of false positive test results.

Implications for Nursing Practice

The implications for the nursing practice included the need for a standardized order set for newborns experiencing neonatal abstinence symptoms, which was developed in collaboration between the departments of nursing and neonatology. All nursing staff received in-service on neonatal abstinence scoring to help staff provide more consistent and accurate scores.