Improving Postpartum Depression Screening and Referrals

Depression is the most common complication associated with the childbearing process, and delayed or inadequate treatment can be detrimental for mother, child and family. Depressive symptoms during postpartum can vary, and the use of a standardized screening tool can aide clinicians in evaluating the presence and severity of depressive symptoms. The project aimed to improve the postpartum depression (PPD) screening and treatment referral process in an outpatient women's health clinic. Eight nurses received an educational session that included information on depression, and the use of the Edinburgh Postnatal Depression Scale (EPDS) and clinical guideline. Effectiveness of the educational session and clinical guideline use was evaluated by comparing Likert scale survey responses from participants before the project and eight weeks following implementation. Survey questions compared the degree of change in the areas of knowledge, comfort level, and confidence related to PPD screening, treatment referral, and management of safety concerns. Participants also provided free text feedback evaluating their experience with the guideline implementation process. Results showed an improved mean score for all measured areas after the intervention was completed. Knowledge increased (pre-M 4.57; post-M 4.71), perceived usefulness regarding a PPD screening tool in clinical practice increased (pre-M 4.42; post-M 4.85), confidence in responding to depressed patients increased (pre-M =1.71; post-M = 4.71), and confidence in managing a suicidal or severely depressed patient increased (pre-M=2.14; post-M = 4.71). Participant feedback included suggestions such as "there should be a question assessing anger" and "I didn't always feel it was necessary to have the patient answer every question in order to get a good assessment of the patient" as well as positive feedback such as "This tool was easy and user friendly" and "I feel more confident now making decisions." The project demonstrated that an educational session and a clinical guideline tailored to the existing workflow of an outpatient clinic could improve knowledge, comfort, and confidence levels for PPD screening and treatment referrals. The clinical guideline utilized in this quality improvement project can be adjusted and/or replicated for use in other outpatient clinics, and updated as new best practice recommendations develop. The success of the process of implementing PPD screening was due in part to the readiness of the clinic staff who dealt with many depressed patients, who were then presented with the knowledge and tools to screen and refer women as needed. The staff was active in deciding how to implement the process of screening in their clinic and this also contributed to its full adoption.