Pregnant individuals entering correctional facilities represent 5-10% of the incarcerated female population, yet consistent prenatal care standards are often lacking. To address this gap, a nurse-initiated prenatal protocol was developed and paired with a continuing professional development session for nursing staff. Training emphasized the use of the Clinical Opioid Withdrawal Scale (COWS), referral thresholds, and protocol-driven prenatal care. Despite challenges, the protocol improved timely initiation of prenatal interventions and advanced nursing-led decision-making.

Educational Objectives

• Explain the significance of implementing a nurse-initiated prenatal protocol in a correctional setting
• Describe the use of the Clinical Opioid Withdrawal Scale to assess withdrawal severity, guide clinical decision-making, and determine when provider consultation is warranted
• Evaluate strategies for educating and supporting nursing staff to build competency and confidence in protocol adoption

Level: Intermediate