Minnesota Nursing magazine
A better start for babies with substance exposure
As nursing director of The Family Birth Center at Park Nicollet Methodist Hospital, Allysia Jenkins, RN, had a concern about the care provided to mothers and babies with intrauterine substance exposure.
Research shows that care coordination and early intervention improve outcomes for infants with substance exposure. But the birth center did not have a care coordination program or a dedicated care coordinator to assist new moms. Adding to the challenge, there was no standardized documentation when infants were born with exposure and the communication between in-patient and out-patient care was lacking. “I was interested in how we could better serve these patients and do it in a way that didn’t stigmatize them, by giving them empathetic, compassionate care,” said Jenkins, who is a student in the Doctor of Nursing Practice program’s health innovation and leadership specialty.
Implementing meaningful change
Jenkins knew that if she was going to be successful at implementing meaningful change, she needed supportive colleagues. “A lot of my role in the project was really helping to build the stakeholder team and then advocating to senior leaders to get resources to implement this project,” said Jenkins.
Ultimately, the team developed a care coordination program and advocated for the hiring of a social worker to help ensure the program was sustainable. “The ability to partner with a social worker was a huge win,” said Jenkins. “Adding her to the team, it was an immediate success. No one was falling through the cracks.” Now, when a cord blood toxicity screen is ordered to identify substance use, a care coordination referral is made automatically. If the test is positive, the social worker initiates a meeting with the family and an out-patient consult order is included in the discharge summary.
An alert was added to the electronic health record to notify providers they need to add the diagnostic code for intrauterine drug exposure on the problem list when appropriate. This ensured the information was easily accessible for all providers. “It’s a flag so these families don’t fall through the cracks,” said Jenkins. Adding the code to the problem list resulted in improved communication between the clinics and birth center.
“This quality improvement project improved the care for these patients by standardizing the methods for identifying exposed infants and developing clear communication channels that supported care coordination services for infants and their families,” said Jenkins.
Jenkins’ work to address the challenge exemplified the DNP program requirement to develop and implement a system-level change. “Allysia took a systems approach to her project. Her team recognized a gap between in-patient and out-patient follow up as well as a lack of consistent support for mothers with substance use and abuse problems. Many health care systems consider their work complete when the patient is discharged from the hospital, but Allysia’s project recognized the ongoing risks and challenges that can impact the lives of infants and mothers,” said Clinical Associate Professor Teddie Potter, PhD, RN, FAAN, who was Jenkins’ adviser.
A bigger footprint
Jenkins sought a DNP degree in health innovation and leadership after realizing she wanted to pursue leadership positions. “I felt like if I was going to do it, I needed skills and resources so that I could do it to the best of my ability,” said Jenkins, who earned a bachelor’s degree in nursing from the University of Minnesota and will graduate with a DNP degree this spring. Jenkins recently accepted a position as a provider engagement executive at the health insurance company Humana. She supports provider groups throughout the nation by sharing data and partnering with them to identify opportunities for improvement. “Up until now, my focus in my career has been very traditional health care, which I absolutely love,” said Jenkins. “This program expanded my perspective that we are a piece of this global puzzle of health care. It is really important for me to have a bigger imprint, a bigger footprint.”