Quality Improvement Project to Improve the Screening Process for Identifying PTSD in the Antepartum Period

Maternal mental health is an essential aspect of care in pregnancy. Some women experience Post Traumatic Stress Disorder (PTSD) before and during pregnancy, which can lead to postpartum PTSD if not treated. This can have long-lasting effects on both the mother and child. If ignored, PTSD can result in higher healthcare costs, illness, and even death. It can also lead to depression, anxiety, less prenatal care, premature birth, reduced bonding between mother and child, lower rates of breastfeeding, and long-lasting psychological problems for both. When PTSD is identified during pregnancy and treated early, it can lead to better outcomes for both mother and child. This project evaluates the implementation of a screening instrument and toolkit for certified nurse midwives (CNM) in an urban setting to improve confidence, competence, and comfort in screening for PTSD during pregnancy. Methods: A quality improvement project was initiated to improve PTSD screening during pregnancy in an urban midwife clinic. The Primary Care Post Traumatic Stress Disorder for the DSM 5 screening tool (PC-PTSD-5) was used to screen for PTSD at the new obstetric visit appointment in the first trimester of pregnancy. A toolkit was developed to educate midwives on the screening tool and provide resources for patients screening positive. A pre-and post-implementation survey was given to participating midwives to assess current screening practices and their confidence, competence, and comfort in screening for PTSD in pregnancy. Chart audits and interviews were conducted to assess the use and distribution of resources. Results: A total of 17 women were screened using the validated PC-PTSD-5 tool. Three (18%) individuals screened positive for probable PTSD, and all were given the resource packet. Ten midwives completed a pre-implementation survey, and five completed the post-implementation survey. Due to the low response rates of the post-implementation survey, a measure of change statistics was unable to be measured. One, 20% of the certified nurse midwives rated the PC- PTSD-5 to be "moderately useful," while four (80%) found it "slightly useful." Appointment length was identified as a consistent barrier to the feasibility of continued use of the screening tool. Four (80%) of the midwives reported being satisfied with the PC-PTSD-5, while one (20%) did not recall seeing or using it. Conclusion: The incorporation of the PC-PTSD-5 screening tool during the NOB visit proved to be a valuable screening tool as an effective and efficient way to screen for PTSD during pregnancy. It is crucial to screen for PTSD during pregnancy to ensure appropriate identification and referral for those experiencing PTSD in pregnancy. Adequate provider training of resources is necessary to improve screening. The next steps and system changes include implementing the PC-PTDS-5 screening tool, regularly updating available resources, and continuing education for midwives. A standardized screening protocol would allow for permanent integration of the PC-PTDS-5 into the electronic medical record (EMR).