| Description |
Background: Postpartum depression (PPD) is the most common obstetric complication in the United States, affecting women after childbirth. The stressful situation of a neonatal intensive care unit (NICU) admission can exacerbate mental health challenges during the perinatal period and increase the risk for PPD. PPD leads to increased medical costs due to more frequent healthcare visits and treatments. PPD increases the risk of abuse and neglect; it can also result in poor breastfeeding outcomes and altered family dynamics. In a local level III NICU, there was no current practice for screening mothers for postpartum depression. The Edinburgh Postnatal Depression Scale (EPDS) was used to identify mothers in need of education and resources for the treatment of PPD to promote better outcomes for families and infants. Local Problem: A local hospital serving an urban area in Utah does not have an established process for screening mothers of infants in the neonatal intensive care unit (NICU) for postpartum depression (PPD) despite their increased risk. Methods: A quality improvement project was implemented using the John-Hopkins Evidenced Based Practice Model to plan, implement, and evaluate the success of incorporating screening on this 30-bed level III unit. Before implementation, staff were surveyed to gain insight into baseline knowledge, comfort level, and perceptions surrounding PPD and the implementation of this project. Education was provided to enhance comfort and knowledge on PPD and screening with the EPDS. Post-implementation, staff were surveyed again to determine usability, feasibility, and satisfaction with the new process for screening for PPD. Charts were reviewed post implementation to track compliance with screening and determine the prevalence of PPD within the unit. Interventions: A pre-implementation survey was conducted among staff to assess baseline knowledge, identify gaps, and evaluate barriers to PPD screening. Key stakeholders were engaged in the development of this screening process. After research and inspection of existing literature, the Edinburgh Postpartum Depression Scale (EPDS) was selected as the screening tool for implementation. Education was provided to unit staff using results from the pre-implementation survey. Education covered PPD risks, prevalence, signs and symptoms, clinical impact, and screening procedures. Following implementation, a post-implementation survey identical to the preimplementation survey was distributed to assess changes in staff knowledge and perception. Results: Sixty-four screenings were returned, 29 pre-implementation surveys and 35 post-implementation surveys. Pre-implementation surveys guided education efforts and workflow development. The post-implementation survey helped assess the effectiveness, feasibility, and usability of the screening process. Following education, staff confidence in discussing PPD increased by 15%. 9 mothers were screened with 1 positive screening for PPD, a prevalence of 11%. 100% of screenings were properly recorded in the electronic medical record. Conclusion: Screening for PPD in the NICU is important for improving the outcomes of both mothers and infants. The risk for PPD is increased among mothers with an infant admitted to the NICU; because of this, regular screening for PPD in the NICU should be a standard of care. Future efforts to improve PPD screening in the NICU should focus on more diverse settings and longterm outcomes. |
