This Doctor of Nursing Practice quality improvement project implemented universal substance use disorder screening for prenatal patients in a collaborative obstetric clinic using an adapted Integrated 5Ps Screening Tool over two Plan-Do-Study-Act cycles. The intervention successfully screened 86.2% of eligible patients, identified substance use risk factors in 38.5% of patients, and significantly improved documentation while increasing provider confidence in screening practices. Results demonstrated that universal substance use screening with the 5Ps tool is feasible and effective when implemented with workflow changes emphasizing patient privacy and stakeholder needs.