Browsing Doctor of Nursing Practice (DNP) Projects by Subject "Prenatal Care"
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Implementation of a Perinatal Dental Screening Tool in an Obstetric PracticeBackground Oral health is an important aspect of overall health and should be maintained during pregnancy. Due to complex physiological changes during pregnancy, the pregnant woman is at risk for developing periodontal disease and dental caries. This is associated with poor birth outcomes including pre-term births and low birth weight infants. Evidence-based guidelines developed by several professional organizations indicate that oral screening should be included in the first prenatal visit. Local Problem Pregnant women enrolled in Medicaid have dental coverage during pregnancy. Despite this, only 27% of these women utilized their dental benefits. The purpose of this quality improvement project was to implement a dental screening tool at an obstetrical practice. The screening tool was used to identify pregnant women with oral health needs and provide subsequent referral to a dentist. Interventions Implementation occurred over fourteen weeks. The screening tool included three maternal oral screening (MOS) questions. The first question was to determine if the patient had a dental cleaning in past twelve months and the other two questions were about dental concerns, pain and bleeding gums. The purpose of the screening was to identify oral health needs and refer to dental provider as appropriate. Patients from all practice locations were screened and received a referral to an existing dental home or one covered by their insurance. Results A total of 826 pregnant women were screened. Of all the pregnant women screened 36.3% (n= 300) had not had their teeth cleaned in the past twelve months. Greater than 30% of pregnant women (n=316) reported some type of dental problem, 244 (29.5%) were screened during the first prenatal visit, and 36.7% (n=303) were enrolled in Medicaid. At the completion of the implementation, the number of dental referrals issued was 616 (74.6%). Conclusion Conducting oral health screenings during the prenatal visit is important for identifying pregnant women at risk for oral health problems and improving birth outcomes. Performing the screening at the first prenatal visit allows the woman time to visit the dentist prior to delivery. Integration of an oral health screening and referral process can be successfully implemented to meet the needs of the pregnant population.
Implementation of an Oral Health Program in a Prenatal Practice SettingBackground Untreated periodontal disease during pregnancy can contribute to adverse health outcomes involving both oral health and pregnancy. Medicaid has offered full dental benefits in its coverage to pregnant women, but there has been a steady decrease in usage with only 26.8% of women enrolled utilizing this benefit. An oral health program that includes screening and referrals, and partnering with a Medicaid accepting dental provider addresses the barriers that pregnant women with Medicaid benefits encounter. Local Problem Prenatal practices have expressed difficulty addressing the oral health care needs of their Medicaid patients. The purpose of this quality improvement project was to implement a dental screening and referral program that would link Medicaid recipients within a prenatal practice to a clinic for oral health care. Interventions The structure of the program was based on the Oral Health Delivery Framework, and implementation occurred over fourteen weeks. The screenings consisted of a three-question selfassessment of dental concerns and one question determining if the patient had seen a dentist within the past twelve months. The purpose of the screenings was to assess the acuity of the dental needs and the level of urgency needed for the referral. All patients screened were then referred for dental care to a local Medicaid dental clinic. A pre-printed dental referral form was used to specify safe medical and dental treatments during pregnancy. Results All patients screened were referred to the clinic resulting in a 100% referral rate. The goals of having a patient’s first appointments scheduled within three weeks of the date of referral (mean time was 3.2 weeks) and subsequently, having treatment plans established within three weeks were not met. Only 7.5% of the women screened had seen a dentist within the past twelve months. The disease burden was found to be high when 70% of those screened had at least one dental concern, and 88.9% of the patients required more than just oral prophylaxis at their dental visit as a treatment plan needed to be established. Conclusion Prenatal practices are an optimal location for assisting women with Medicaid benefits to access dental care early in pregnancy. Prior identification of a Medicaid dental clinic was a critical component to the program’s success. The screenings provided the opportunity to determine the urgency of the referral. Using a dental referral form was beneficial to communicate safe treatments to the dental provider. Establishing the first scheduled appointment within three weeks of being referred to the dental clinic was the most significant barrier encountered. Expanding this program to include additional providers would potentially address this barrier and assist with increasing access to dental care for this population.
Screening, Brief Intervention, and Treatment in a Latina Immigrant Prenatal ClinicProblem & Purpose: Babies born in Maryland found with drugs in their systems has increased 57.6 percent in the last 9 years. The American College of Obstetricians and Gynecologists recommends universal screening for substance use disorders at first prenatal visit. Substance use disorders are usually interrelated with other behavioral health issues requiring more comprehensive screening at primary care sites for better screening and treatment success. The use of a Screening, Brief Intervention, and Referral to Treatment (SBIRT) protocol combined with motivational interviewing (MI) has shown success in earlier identification and more successful referrals of behavioral health issues. The aim of this MAP-IT guided (Mobilize, Assess, Plan, Implement, Track) quality improvement project is to educate, better detect, and successfully refer out a Latinx immigrant prenatal patient population with suspected behavioral health issues to specialty behavioral health treatment centers to decrease negative long term behavioral health issues occurring in the community. Methods: Implement an SBIRT protocol for behavioral health. Train and use MI techniques when interacting with patients; support patients throughout the specialty referral process by being present and using same-day appointments; increase education about of behavioral health issues and their treatment; and track behavioral health issues from the clinic to the specialty referral site. Results: During the 12-week implementation period, four patients were identified with behavioral health issues with one patient being successfully referred to county behavioral health. Conclusions: The Latinx immigrant culture stigmatizes behavioral health. Increasing education and trust for behavioral health treatment must be a focus. Prenatal clinic employees should be trained in MI techniques and cultural engagement to successfully engage in patient collaboration for behavioral health issues. Repeated behavioral interventions are needed to increase the motivation needed to accept treatment. Behavioral health experts embedded in prenatal clinics would help make referrals and treatment more successful.