November 14, 2019 marked the kickoff for the newest maternal quality improvement initiative developed by the Florida Perinatal Quality Collaborative (FPQC) – the Maternal Opioid Recovery Effort (MORE).

Over 120 representatives from 23 hospitals, 11 Healthy Start Coalitions, several Medicaid managed care organizations and state agencies attended this day-long event held in Orlando.

Opioid use by pregnant women has been increasing throughout Florida and across the nation. The number of women in the US using opioids during pregnancy increased nearly 70% between 2015 and 2017. In Florida, the number of women with opioid use disorder (OUD) in labor and delivery quadrupled between 1999 and 2014. In addition, Florida experienced a ten-fold increase in Neonatal Abstinence Syndrome from 2002-2012.

In light of these alarming statistics, FPQC, with the advice and support of an incredibly diverse advisory committee, developed an initiative to provide MORE for pregnant women using opioids: More attention; More support; More services; More follow up; More compassion.

Special guests Victoria Camper and Helena Girouard shared their journey through opioid use, pregnancy and recovery. Facilitated by Dixie Morgese, Executive Director of the Healthy Start Coalition of Flagler and Volusia Counties, they each described the stigma they felt, their experiences during their pregnancies, the impact of their prenatal and labor and delivery caregivers, and the support they received from their families and community agencies.

A comment from her obstetrician, “You have potential,” set Helena on the road to recovery.  Comments from the audience included “It was nice to see the barriers to appropriate care of OUD patients are everywhere. Hearing the stories from the patient side gave great insight into establishing a therapeutic relationship with that population.”

This panel was followed by a presentation from the MORE Initiative clinical lead, Dr. Jan Lanouette, who described the history and scope of the opioid epidemic in Florida’s pregnant women. She emphasized the need to compassionately address mental health issues and other co-morbidities disproportionately experienced by pregnant women who use opioids.  The need for universal substance use screening for all pregnant women, using a validated verbal screening tool as a part of SBIRT (Screening, Brief Intervention, and Referral for Treatment) is a critical first step in addressing opioid use in pregnancy in Florida.

Dr. Ann Borders, Director of Illinois Perinatal Quality Collaborative’s Mothers and Newborns Affected by Opioids initiative, spoke about successes and barriers to addressing this issue in her state. She emphasized that the medical community must understand that opioid use is a life-threatening chronic disease, especially for pregnant and postpartum women. It is the leading cause of pregnancy-associated deaths in Illinois. Dr. Borders described successful interventions implemented in Illinois (many of which are included in Florida’s MORE) which have resulted in more pregnant women with opioid use being identified and provided medication-assisted treatment.

After lunch, the focus moved to implementation of the MORE Initiative, including an overview of the MORE toolkit and resources, the MORE key driver diagram and measures and specific guidance on next steps for teams from FPQC staff. Ellen French, Perinatal Quality Specialist at Sarasota Memorial Hospital, gave firsthand advice on how to implement a successful quality improvement initiative.

Another popular session was facilitated by Lori Reeves and Carol Brady, MORE community liaison coordinators, highlighting successful community partnerships addressing OUD in pregnant women. The session focused on creating a connected network of community partners that work together to support efforts to help more women access treatment during their pregnancies and continue treatment after their baby is born. 

A panel, including Dr. Washington Hill, Sarasota Memorial Hospital, Susan Beauvois, Executive Director of the Healthy Start Coalition of Southwest Florida, and Cathy Dupont, Healthy Start Director for the Northeast Florida Healthy Start Coalition discussed successful partnerships that have been developed in their communities. These include opportunities to coordinate with Medication Assisted Treatment (MAT) providers, as well as child welfare, the justice system and home visiting programs. The MORE initiative will help participating hospitals create a comprehensive map of services available in their communities.

Each hospital has assembled a quality improvement team including physician, nurse, and administrative champions. Over the course of the initiative, the FPQC will provide monthly quality improvement data reports for each hospital, a toolkit and an online toolbox with resources and tools, and technical assistance to assist hospitals in implementing process changes and improving documentation. The FPQC is available to provide on-site or remote technical assistance, Grand Rounds presentations, and webinar learning sessions to further assist initiative hospitals with implementation.

Also at the meeting, Lori Reeves presented the 2019 March of Dimes Lawton Chiles Service Award to Dr. Bill Sappenfield, Director of the FPQC. The award recognizes an individual whose work has positively influenced the advancement of maternal and child health in the state of Florida in the areas of leadership, advocacy, evidence informed interventions, collaboration, and/or reducing health disparities.

For more information on the MORE Initiative, visit www.fpqc.org/more

Article by Betsy Wood and FPQC staff