Florida Perinatal Quality Collaborative
MORE Initiative
As of June 2022 the MORE Initiative has moved into Sustainability, but we encourage you to download and share our Toolbox Resource List!
Maternal Opioid Recovery Effort
Urgent Maternal Mortality Message for Providers from Florida PAMR: Overdoses are now the leading cause of pregnancy-associated death in Florida. Obstetric providers, nurses and hospitals are the first health care contact for most mothers with Opioid Use Disorder (OUD) and need to lead the effort to screen, assess, and refer these mothers for OUD treatment.
The rate of pregnant women diagnosed with opioid use disorder (OUD) during labor and delivery in the U.S. more than quadrupled from 1999 to 2014, according to a 2018 analysis by the Centers for Disease Control and Prevention (CDC). In Florida, the rate climbed from 0.5 per 1,000 delivery hospitalizations in 1999 to 6.6 in 2014.
This project’s purpose is to work with providers, hospitals, and other stakeholders to improve identification, clinical care and coordinated treatment/support for pregnant women with opioid use disorder and their infants.
Project Focus
Standardization related to:
- OUD Screening
- Prevention
- Treatment
- Comprehensive Discharge Planning
Learn about our parallel infant health NAS Initiative.
Two Free Buprenorphine CME Training Webinars for OB Providers—1.25 hours of AMA PRA Category 1 Credits
In partnership with the Tennessee Initiative for Perinatal Quality Care, FPQC is offering a free CME training on Buprenorphine use in obstetrical practice. The first session describes the basics of Buprenorphine treatment during pregnancy. The second session describes how to make prescribing Buprenorphine in your obstetrical practice work. Both of these sessions with assistance from Florida’s Behavioral Impact Project can help you include in your OB practice.
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The MORE Online Toolbox contains resources for our Maternal Opioid Recovery Effort and our Neonatal Abstinence Syndrome projects, including provider and staff education, screening tools, community resources, patient education. This resource is updated regularly throughout the project.
Online Toolbox for Opioid Initiatives
Resources specific to MORE for Hospital Implementation:
- FPQC's MORE Initiative Tool Kit document
- FPQC's MORE Quick Start Checklist for participating teams
- Alliance for Innovation on Maternal Health (AIM) bundle: Obstetric Care for Women with Opioid Use Disorder
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Slide sets and presentation recordings when available are below. Please email us if you would like these any of these slides for use in your own institution.
MORE Celebration Webinar (May 2022)
MORE 2.0 Mid-Point Meeting (October 2021)
- Introduction
- Where We Are, Initiative-Wide
- Promising Practices for Educating Busy OB Providers & Staff
- Compassion for your Brain in the Midst of Chaos
MORE 2.0 Kick Off Presentations (May 2021)
MORE Mid-Project Meeting Presentations (Oct 2020)
- Welcome and Introduction
- Where We Are Initiative-Wide
- Lessons learned in Massachusetts on System Improvement for Care of Patients with SUD in Pregnancy
- Advancing Health Equity and Social Justice: Using a Trauma-Informed Lens
- Take Home Messages from the Meeting
MORE 1.0 Webinars
Webinar with Dr. Mishka Terplan: Engaging Women With OUD in the COVID19 Crisis: Tools and Principles - June 2020
Webinar with Dr. Michael Marcotte: Partnering to Help Women with Opioid Use Disorder - June 2020
Overview of the MORE Initiative - February 2020
Data Collection for the MORE Initiative - December 2019
MORE Kick Off Presentations (Nov 2019)
- Welcome
- Background on the Maternal Opioid Issue
- Mom Panel (Video)
- MORE Tool Kit and Resources
- MORE Implementation Guidance
- Essential Community Partnerships
- MORE Data: Key Drivers and Measures
2019 Chiles Lecture: Dr. Elizabeth Krans
Maternal Opioid Use: Latest Research and Practice
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The FPQC has worked with partners to create videos for staff education related to substance use disorder and neonatal abstinence syndrome.
MORE Video WebsiteMORE YouTube Video Playlist
These videos can be used in a variety of ways! Here are some ideas:
- Use as a way to kick off a team meeting or a department meeting
- Show at OB division meetings where nursing, physician, and C-suite leaders are present to raise awareness of MORE
- Share on social media and promote via your website
- Show to OB Chief and OB Medical Director and ask for the best way to present the information at their hospital
- Perinatal safety team discussions
- Incorporate into training, education, or events
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As part of the Maternal Opioid Recovery (MORE) initiative, FPQC has compiled resources for prenatal care providers and their patients to encourage and support the early identification of pregnant women with Substance/Opioid Use Disorder (SUD/OUD), and link them with available services before delivery.
Overview of Resources:
- A letter from Dr. Jan Lanouette, MORE Medical Lead (PDF) describing the FPQC project work with participating hospitals. Dr. Lanouette underscores the importance of SUD screening and outlines resources and training available to practitioners.
- MORE Prenatal Care SUD Screening Algorithm (PDF) providing a flow chart for SUD screening and responding to results.
- Screening, Brief Intervention, Referral to Treatment (SBIRT) Videos:
- Implementation of SBIRT, MORE Physician Lead Dr. Jan Lanouette reviewing the importance of SBIRT. Medicaid billing is discussed. This video was created by the USF Morsani College of Medicine and is approved for CME.
- SBIRT: A Universal Tool for Pregnant Women, Dr. Pam Carbiener and MORE Patient Partner Helena Girouard performing a role play to help guide providers through the SBIRT process.
- MORE Prenatal Checklist (PDF) for documenting efforts to identify and address perinatal substance in the office setting. The checklist can be adapted to reflect specific office practices and protocols.
- Community Mapping Tool Modifiable Template
- Sample Completed Community Mapping Tools:
- Morton Plant Hospital (Pinellas)
- Cleveland Clinic Indian River Hospital
- Memorial Regional Hospital (Broward)
Resources for Providers:
- SBIRT Pocket Card (PDF)
- Narcan Information for Providers (PDF)
- Trauma-Informed Care Tip Sheet (PDF)
- Florida Behavioral Health Impact initiative Flyer (PDF)
- ACOG’s Opinion on Tobacco and Nicotine Cessation During Pregnancy (PDF)
- Recommended screening tools:
- Sample Plan of Safe Care
- Quick Start Tip Sheet (PDF) to help prenatal care providers integrate screening and follow-up into their practices.
Resources for Patients:
- The MORE Hope Booklet (PDF) developed in collaboration with the Hillsborough Healthy Start Coalition. The booklet provides comprehensive education and guidance to women affected by substance use.
- Brochure on Opioid Safety & How to Use Naloxone (PDF)
- Palm Card Resource Template (editable in Adobe Acrobat Professional or Adobe Illustrator)
- Information on postpartum birth control, emphasizing the benefits of long-acting reversible contraception (LARC) (PDF)
Community/Provider Liaison Resources:
- Prenatal Provider Resources: Tips for Healthy Start Coalitions (PDF) provides an overview of resources for prenatal providers and their patients, and best practices for disseminating this information in your community. It also highlights strategies and resources for training prenatal care providers and other community programs that serve pregnant women and their families.
- Voices from the Community (Video Snippet): This 6-minute snippet featuring Karen Woulf (Provider Liaison, Healthy Start of North Central Florida) describes the importance of educating and providing resources to community and prenatal providers so they can better support pregnant people with SUD.
- FAQs to help answer provider questions about reimbursement, screening tools, and other topics.
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MORE Hospital Folders were sent to our hospital teams and are intended to be given to patients who screen positive for OUD. Learn more about how to implement the MORE Folder from this quick snippet featuring MORE Nurse Consultant Margie Boyer!
We recommend all folders contain the following items:
- Letter of Support from the MORE Medical Lead
- Helping Our Parents Excel (MORE HOPE) Booklet
- MORE sticker template
- Naloxone patient education brochure: Opioid Safety
- Narcan Provider Info page (ILPQC)
- ACOG Committee Opinion #807: Tobacco and Nicotine Cessation During Pregnancy
- MORE SBIRT Pocket Card
- Postpartum LARCs: Are You Ready?
- Trauma-Informed Care Flyer
- Florida Behavioral Health Impact Flyer
Additional items recommended for the MORE Hospital Folder:
Additional items recommended for the MORE Community Provider Screening and Resources Folder/Binder:
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- MORE Key Driver Diagram
- MORE Measurement Grid v. 11/2019
- MORE Monthly Data Collection Sheet v. 2/2021
- MORE Quarterly Data Collection v. 11/2019
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- AdventHealth Celebration
- AdventHealth Daytona Beach
- AdventHealth Deland
- AdventHealth Ocala
- AdventHealth Orlando
- AdventHealth Sebring
- AdventHealth Waterman
- AdventHealth Winter Park
- Ascension Sacred Heart Emerald Coast
- Ascension St. Vincent's Riverside
- BayCare - Morton Plant Hospital
- BayCare - St. Joseph's Women's Hospital
- Bayfront Health Port Charlotte
- Broward Health Medical Center
- Cleveland Clinic Indian River Hospital
- Gulf Coast Regional Medical Center
- Halifax Health
- Jackson North Medical Center
- Lakeland Regional Health
- Lee Health Cape Coral Hospital
- Lee Health HealthPark Medical Center
- Manatee Memorial Hospital
- Memorial Regional Hospital
- NCH North Naples Birth Place
- Orange Park Medical Center
- Orlando Health Winnie Palmer Hospital for Women and Babies
- Rockledge Regional Medical Center
- Saint Mary's Medical Center
- Sarasota Memorial Healthcare System
- Tampa General Hospital
- UF Health Jacksonville