(251) Implementation of an equity-driven peripartum toxicology testing policy

Objective: Guidelines for obtaining peripartum toxicology testing vary, decisions are commonly subject to provider bias, and consent is poorly obtained. To address inequities in peripartum toxicology testing at our institution, in 1/2022 we implemented an equity-driven toxicology testing policy for birthing persons and newborns. Key revisions included removal of testing indications that had been disproportionately invoked for birthing persons of color with few unexpected positive results and introduction of written consent forms for testing birthing person urine and newborn meconium. We aimed to evaluate provider adherence to the updated policy.

 

Study Design: Medical records of birthing person-newborn dyads with peripartum toxicology testing at our hospital between 1/2022 and 6/2022 were reviewed for testing indication and documentation of consent. The proportion of individuals with policy-concordant testing indications and written consent were calculated.

 

Results: In the 6 months following implementation, a total of 29 dyads underwent toxicology testing. Among the 18 birthing persons with urine toxicology testing, 83% had policy-concordant testing indications, while 39% had documentation of written consent. Among the 22 newborns with urine or meconium toxicology testing, 86% had policy-concordant testing indications; for newborns with meconium toxicology testing, 85% had documentation of written consent. Among dyads with policy-discordant testing indications, only 25% had documentation of verbal or written consent.
 

Conclusion:
Adherence to hospital policy testing indications for birthing person and newborn toxicology testing was high ( >85%), however, written consent for birthing person toxicology testing was notably low. The low rate of consent among dyads with policy-discordant testing indications may be suggestive of inadequate provider education or discomfort obtaining written consent required in the new policy. Ongoing work will evaluate the policy’s impact on disparities in testing, as well as barriers to obtaining consent for peripartum toxicology testing.