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Show Enhancing NICU Care: A Quality Improvement Project for Implementing Screening for Postpartum Depression Rachel Willis, BSN, RN; Content Expert Rachel Brown, MSW; Project Chair Julieanne Schiefelbein, DNP, MA(Ed), MAPPSc, NNP-BC, CPNP Key Take Away . Implementing postpartum depression screening in the NICU ensures early identification and intervention, improving maternal mental health and enhancing infant outcomes. Background Results • • • • Postpartum depression (PPD) is the most common obstetric complication in the United States. Having an infant in the NICU puts mothers at an increased risk for PPD. PPD leads to increased medical care costs. PPD may increase the risk of abuse and neglect. • • • Purpose The purpose of this Doctor of Nursing Practice (DNP) evidenced-based quality improvement project is to create and integrate a screening process for PPD in a local NICU, increase the identification of mothers with PPD, and provide resources. • • Methods • • • • • Surveys were distributed pre- and post-implementation to establish baseline knowledge and perceptions of staff Education on PPD and using the Edinburgh Postnatal Depression Scale was created using findings from the preimplementation survey and distributed to staff in person at staff meetings, hard copies of the education were posted around the unit for reference and reminders. A handout with tools for PPD was added to the admission packet. A workflow process for screening for PPD, documenting results, and referring to unit social work was developed and integrated. Post-implementation surveys were used to determine feasibility, usability, and satisfaction of the education and workflow. Chart reviews were performed to assess documentation and results of the screenings. Staff confidence discussing PPD increased by 15% following education, and understanding of PPD risks improved, with 100% of staff agreeing post-implementation. Screening required minimal cost and time; no additional staffing needed. Of the responses to perceived barriers to PPD screening, 47% stated concerns for stigmas surrounding PPD and mental health. 11% of screened mothers had a positive EPDS score (>12), aligning with general population estimates but potentially underreported due to stigma and study limitations 93% of staff agreed that PPD screening is important, and multiple staff members expressed gratitude for addressing this issue. Conclusions PERCEIVED BARRIERS TO IMPLEMENTATION OF POSTPARTUM DEPRESSION SCREENING IN THE NICU 47% STIGMA 27% KNOWLEDGE • • • 23% RESOURCES • LANGUAGE • 3% Language Resources Knowledge Stigma Screening for PPD in the NICU improves maternal and infant outcomes. Limitations of this project include a small sample size, limiting the generalizability of the findings, as well as time. Selection and measurement biases are potential limitations due to maternal willingness to participate and self-reported data. With minimal cost and time requirements and high staff support, there is strong potential for continued implementation in NICUs. Education on PPD and mental health awareness is vital to combating social and cultural stigmas. Future projects should focus on implementing in more diverse NICU settings and following the long-term impacts of routine screening to understand disparities in PPD identification and treatment. @uofunursing @utnurseresearch |
