Book contents
- Frontmatter
- Contents
- Editors
- Contributors
- Foreword
- Preface
- Introduction
- Completing an audit project
- I Disorders
- 1 Acute confusion: recognition
- 2 Antenatal and postnatal mental health
- 3 Attention-deficit hyperactivity disorder: provision of information
- 4 Bipolar depression: treatment
- 5 Bipolar disorder: management
- 6 Bipolar disorder: shared decision-making
- 7 Bipolar disorder: treatment
- 8 Chronic fatigue syndrome
- 9 Dementia: driving
- 10 Dementia: end-of-life care
- 11 Dementia: investigations
- 12 Depression: management in children and young people
- 13 Eating disorders: management
- 14 Epilepsy: management
- 15 Opiate dependence and pregnancy
- 16 Schizophrenia: family interventions
- 17 Schizophrenia: management
- 18 Schizophrenia: occupational achievements
- 19 Self-harm: assessment
- 20 Self-harm: assessment in children
- II Legislation
- III Physical health
- IV Record-keeping
- V Service provision
- VI Training
- VII Treatment
- Appendices
15 - Opiate dependence and pregnancy
from I - Disorders
Published online by Cambridge University Press: 02 January 2018
- Frontmatter
- Contents
- Editors
- Contributors
- Foreword
- Preface
- Introduction
- Completing an audit project
- I Disorders
- 1 Acute confusion: recognition
- 2 Antenatal and postnatal mental health
- 3 Attention-deficit hyperactivity disorder: provision of information
- 4 Bipolar depression: treatment
- 5 Bipolar disorder: management
- 6 Bipolar disorder: shared decision-making
- 7 Bipolar disorder: treatment
- 8 Chronic fatigue syndrome
- 9 Dementia: driving
- 10 Dementia: end-of-life care
- 11 Dementia: investigations
- 12 Depression: management in children and young people
- 13 Eating disorders: management
- 14 Epilepsy: management
- 15 Opiate dependence and pregnancy
- 16 Schizophrenia: family interventions
- 17 Schizophrenia: management
- 18 Schizophrenia: occupational achievements
- 19 Self-harm: assessment
- 20 Self-harm: assessment in children
- II Legislation
- III Physical health
- IV Record-keeping
- V Service provision
- VI Training
- VII Treatment
- Appendices
Summary
Setting
This audit is relevant to addiction teams who are involved in treating opiate dependence in pregnancy.
Background
The extent of drug use in pregnancy is underestimated owing to the stigma and secrecy associated with problem drinking and drug use. The Confidential Enquiry into Maternal and Child Health (2007) reported that substance misuse was directly or indirectly related to 57 out of 295 reported deaths (12 of people dependent on alcohol, 45 of people dependent on illicit drugs). The report concluded that more women were dying from the consequences (direct and indirect) of substance misuse than from other psychiatric causes. The majority of them did not get care from integrated drug addiction services or were poorly managed, with significant inter-agency communication failures.
Standards
The standards for this audit were obtained from Drug Misuse and Dependence: UK Guidelines on Clinical Management (Department of Health, 2007):
ᐅ All pregnant mothers who are opiate dependent should receive substitute drugs to achieve stability. Alternatively, detoxification, if preferred by the patient, can be given but only after the first trimester.
ᐅ Management should involve good inter-agency liaison and care coordination.
ᐅ The risks and benefits of treatment/medications should be discussed with all patients, and the discussion documented.
Method
Data collection
A time period was chosen that was long enough to allow a reasonable number of pregnancy cases to be examined but short enough to make clarifications required by key workers reliable. Key workers from each addiction team identified women who were pregnant in the audit period. The case notes were then examined to answer the following questions relating to the above standards:
ᐅ Did the patient receive substitute drugs to achieve stability or detoxification?
ᐅ If patient received substitute drugs to achieve detoxification, was detoxification done after the first trimester?
ᐅ Was patient's treatment preference (substitute drugs for stability or detoxification) clearly documented?
ᐅ Was a risk–benefit analysis of treatment discussed and clearly documented?
ᐅ Did the management involve good inter-agency liaison in the following domains:
▹ correspondence with the general practitioner (GP)
▹ liaison with midwives, community mental health teams, housing departments and children's, school and family services where appropriate
▹ professional meetings with professionals and agencies involved in client's care planning
▹ services delivered to drug-using partners
- Type
- Chapter
- Information
- 101 Recipes for Audit in Psychiatry , pp. 49 - 50Publisher: Royal College of PsychiatristsPrint publication year: 2011