Postpartum Depression: Development and Evaluation of a Screening Workflow Process in the Neonatal Intensive Care Unit

POSTER

Postpartum Depression: Development and Evaluation of a Screening Workflow Process in the Neonatal Intensive Care Unit Chloe LaBerge, BSN, RN; Jenn Anker, LCSW; Julieanne Schiefelbein, DNP, MAPPSC, MA, ENM, NNP-BC, CPNP, NPT-C; Jenny Hearne, DNP, APRN, NNP-BC, C-NNIC Key Take Away . Through the implementation of a standardized postpartum depression (PPD) screening workflow process, there was an increase in the rate of positive PPD screens in mothers of NICU infants. Results Background • • • • • • PPD is the most common complication of childbirth Mothers of NICU infants are at an increased risk of developing PPD A drastic decrease in progesterone and estrogen in the postpartum period may lead to development of postpartum mood disorders PPD is vastly under-identified, under-diagnosed and undertreated Infants, mothers, and families are at risk for long-term consequences due to PPD Routine PPD screening has been shown to increase identification and treatment of mothers of NICU infants with PPD, and there is a paucity in the literature of NICU mothers being screened for PPD Methods • • • • • A pre-survey was created and distributed to NICU caregivers to determine baseline perceived knowledge of PPD and barriers to screening Developed and implemented a workflow process for PPD screening, documentation, and referral for positive screenings Educational material was created about PPD and the screening workflow and was distributed via email and inperson, based on perceived knowledge deficits A post-survey was distributed to NICU caregivers to determine feasibility, usability and satisfaction of the PPD screening process Measured change in PPD identification, documentation and referral rates Pre- and Post-Implementation Survey Results: • Self-reported knowledge of PPD signs/symptoms increased from 67.3% to 80.9% • Self-reported comfort level discussing PPD with mothers of NICU infants increased from 45.4% to 66.7% • Self-reported knowledge of the long-term effects of PPD increased from 34.6% to 57.2% • The open response question addressed feasibility, usability and satisfaction of the workflow process Implementation Results: Prior to implementation, there were 0 PPD screenings completed Post-implementation, 18 Edinburgh Postnatal Depression Scale (EPDS) screens were completed • The social work team was notified of all 4 positive EPDS screenings • 22% positive screening rate for PPD (n=4), defined by EPDS score ≥ 10 • 33% accurate documentation of PPD screening in EMR (n=6) • 33% of EPDS screenings completed in Spanish (n=6) Conclusions Implementation of a workflow process increased knowledge and identification of NICU mothers with PPD • NICU mothers in this sample were found to have higher prevalence of PPD than the general population • Continuation of the workflow process is recommended to increase identification and treatment in attempt to prevent negative longterm consequences • Limitations: small sample size, limited population of a level III NICU Future Projects: • Improve documentation of PPD in EMR • Continuous PDSA cycles to evaluate the positive PPD screening rates, referral and treatment, and long-term outcomes on infants • Expansion of workflow process to other NICUs in the region • @uofunursing @utnurseresearch