title: A search for guidance: examining prenatal substance exposure protocols.
abstract: OBJECTIVE
  To describe key elements of a set of hospital prenatal substance exposure protocols, and to relate variations in protocol content to the state legislative environment and hospital characteristics.
  
  
  METHODS
  Nurse managers and hospital administrators with responsibility for perinatal care were asked to provide their hospital's prenatal substance exposure protocol. Using a structured coding form, two independent coders read and abstracted information from the 87 protocols received. Hospital and patient characteristics and the state's legal environment were cross-tabulated.
  
  
  RESULTS
  Only half of coded protocols included an implementation date; 37% lacked any goal or statement of purpose. Most covered the key components of prenatal substance exposure management, such as precipitants and guidelines for toxicology screening, but failed to present their contents clearly. Only a few discussed whether specific maternal consent is required for a maternal or a newborn toxicology screen. Protocols from states that had made some legislative response to prenatal substance exposure were more likely to provide reporting guidelines and a discussion of consent for a toxicology screen for mothers and newborns. Protocols were more likely to be found in larger hospitals and were more detailed in hospitals serving more affluent and less minority patient populations.
  
  
  CONCLUSIONS
  More attention needs to be devoted to the development of prenatal substance exposure protocols, as their lack of clarity precludes most from meeting protocol development goals, such as encouraging standardized care. Associations between hospital characteristics, state legislative environment and protocol features suggest that legislative mandates could shape their development and features.
authors.affiliation: RAND, Santa Monica, California 90407-2138, USA.
authors.forename: Gail L
authors.initials: GL
authors.lastname: Zellman
authors.forename: Christine
authors.initials: C
authors.lastname: Fair
authors.forename: Jill
authors.initials: J
authors.lastname: Houbé
authors.forename: Michael
authors.initials: M
authors.lastname: Wong
mesh_terms: D002985:Clinical Protocols; D005260:Female; D019538:Health Care Surveys; D006739:Hospital Administration / Q000592:standards*; D006801:Humans; D007231:Infant, Newborn; D019221:Mandatory Reporting; D009357:Neonatal Abstinence Syndrome / Q000175:diagnosis*; D015997:Neonatal Screening / Q000331:legislation & jurisprudence / Q000592:standards*; D016134:Organizational Policy; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D015813:Substance Abuse Detection / Q000331:legislation & jurisprudence / Q000592:standards*; D014481:United States