Pregnant patients who screen positive for substance use require specialized prenatal care coordination, yet many practices lack standardized protocols for substance use management. This quality improvement project implemented a structured toolkit to enhance substance use screening and care coordination within a collaborative nurse-midwifery and obstetric practice in the Pacific Northwest lacking dedicated social work support or perinatal substance use disorder providers. The toolkit included scripted SBIRT documentation templates and a comprehensive prenatal care checklist with integrated community resources. Implementation over 9 weeks demonstrated improved SBIRT documentation rates and provider comfort with discussing mandated reporting, though declining provider engagement suggests opportunities for workflow optimization. This project highlights both the potential benefits and challenges of standardizing substance use screening and management in prenatal care settings.