When the White House calls seeking your expertise, it is a pretty good indication that you are doing something right. That is exactly what happened to Jessica Bacon, CNM, APRN, MSN, and her colleagues at Wentworth-Douglas Hospital in Dover, New Hampshire.
Among her duties in the hospital’s Women and Children’s Unit, Bacon is part of Seacoast STRENGTH, the multidisciplinary care team for pregnant people with substance use disorder. She and her colleagues, Katie White, RN, and Lindsay Ginter, Case Manager, met with Federal officials via Zoom to answer their questions about their approach to caring for pregnant people who have substance use disorder.
“As they were getting ready to roll out their recommendations for programming, they reached out to different hospitals that have programs for substance use and pregnancy just to talk about the barriers and what has been working well,” Bacon said of the hour-long meeting with the White House representatives. “They were just trying to gather ideas from different people. We discussed where we currently are at with our program and what our hopes are going forward.”
Their goals are ambitious but attainable, much like Bacon’s were growing up in Ludlow, Massachusetts. By the time she was in high school, she already knew she wanted to work in women’s healthcare. She went to nursing school and worked as a nurse for 12 years before graduating from Frontier Nursing University as a nurse-midwife in 2012.
Like the rest of the country, substance use is prevalent in New Hampshire, Bacon says. A sad fact that led to the creation of the Substance Use Disorder Team.
“It’s an example of something that is being developed out of need, unfortunately,” Bacon said. “In New Hampshire, we have a high rate of opioid use disorder. It’s especially concentrated in the area that we live and work in. The New Hampshire Maternal Mortality Review Committee recently cited that 62 percent of our maternal mortality is related to a drug overdose. In our area, it’s not really the postpartum hemorrhages and untreated hypertension that’s killing people. It’s a drug overdose, particularly seven to 12 months postpartum.”
The overwhelming data demonstrated the need, and Bacon and her colleagues began to develop a plan. With the support of the hospital administration, Seacoast STRENGTH became reality. The learning curve was steep, however.
“From precepting different students, I think that there is now some integration of substance use disorder into the midwifery programs, but it wasn’t a thing when I was in school, and the same was true for most of the providers here,” Bacon said. “We just kind of jumped in and learned everything that we could about it because we were having people present to us in withdrawal. Unfortunately, even though we had local prescribers of buprenorphine, a lot of them wouldn’t prescribe to people that were pregnant because they were concerned about the effect on the pregnancy. There is, in recent years, lots of data establishing that both methadone and buprenorphine are appropriate medications for opioid use disorder in pregnancy.”
The care provided is free of judgment and infused with compassion and a simple desire to help someone who is ill. Treating the immediate threat and establishing a level of trust are essential first steps toward long-term positive outcomes.
“We try our best to normalize it like any other chronic condition – just like people with diabetes need extra care or extra medications,” Bacon said. “This is a chronic disease.”
All patients are screened verbally when they present for alcohol or opioid use. With consent, they may also be drug tested. Bacon says those tests almost always indicate that the street drugs are being laced with any number of other drugs, such as meth, cocaine, fentanyl, and heroin.
“When we get these test results, it reveals that the drugs are contaminated,” Bacon said. “That’s what is contributing to a lot of the overdoses because you don’t know what you’re getting. It’s no longer a single substance in most cases. So, we have to keep in mind the model of risk or harm reduction, where anything we can do for them is better than them getting opioids off the street and having these lethal overdoses.”
There are many hurdles to keeping these patients off the street, starting with getting them to ask for help in the first place. Transportation, insurance, finances, and lack of trust are imposing hurdles. Bacon said the Unit treats between 40 and 50 patients with opioid disorder per year, dating back to 2017.
“Pregnancy seems to be a pretty motivating time for people,” Bacon said. “It’s a time when people want to make changes in their life, but it’s really hard. So it’s not uncommon to make contact with people three or four times before they are even willing to attempt medications. We are in the process of developing a program where people can come to us, and we will support them with initiation for either buprenorphine or methadone. With help of the hospital’s Substance Use Response Team, we have done a lot of training with our providers and nurses for trauma-informed care, motivational interviewing, and all things substance abuse related. With time, the staff has gotten really comfortable with the process.”
As one process is perfected, the next looms on the horizon. Transportation and childcare remain the most significant hurdles for most patients. The thought of having to go to obstetric appointments, recovery services, and their buprenorphine prescriber can be overwhelming.
“Our goal this year is to integrate that recovery care with prenatal care as well,” Bacon said, noting that they have applied for grants to support this goal. “We have a small team of us that are going to provide continuity of care for the prenatal care. They will be able to get their prenatal care and recovery services all at the same time. They are going to come once a week for a two-hour session. An hour of that will be group work with a curriculum where we discuss safety planning, relapse prevention, emotional regulation, and other similar topics. They also will attend classes such as childbirth education and breastfeeding. Included an hour where they can meet individually with me for prenatal care or their case manager to work on the social determinants of health and get the resources that they need.”
These types of projects and planning come naturally to Bacon, who is also the nursing practice specialist at Wentworth Douglas. She is responsible for being up to date on current evidence-based practice and working with her team to implement policies, procedures and programs as needed to fill gaps in care. Because of those responsibilities, Bacon came back to Frontier and is currently enrolled in the DNP program (Class 48).
“In this role as the nursing practice specialist, I’m doing a lot of quality improvement work, and I want to do it right,” Bacon said of her decision to pursue her DNP.
The decision to return to Frontier was just as easy as her initial choice to attend Frontier to become a certified nurse-midwife.
“The initial draw (to Frontier) was the ability to do the courses in my own community,” she said. “I had young kids, and I had a job here. Picking up and moving and going to a brick-and-mortar school was not feasible for me because there are none in my area. Frontier has been doing distance learning for a very long time, and they’ve worked out a lot of the kinks. I think now you’re seeing more and more institutions offer that as an option; they’re still having to work through a lot of those issues, whereas Frontier had done that work long before I got there. My experience there was great.”
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