Nurse education is key to successfully screening women for postpartum depression, which affects about 15% of mothers, according to a new quality improvement (QI) study from Cedars-Sinai.
Training that helped nurses become comfortable with the topic of depression and developing a non-judgmental attitude and openness to patient questions and concerns is important.”
Eynav Accortt, PhD, principal investigator of QI Review and director of the Reproductive Psychology Program at Cedars-Sinai
Depression and anxiety are one of the most common perinatal medical complications during pregnancy or in the first 12 months after delivery. Postpartum depression that occurs after childbirth is often characterized by persistent sadness, fatigue, feelings of hopelessness and worthlessness, and trouble sleeping or eating. Some women find it difficult to care for their new baby.
Hospitals have been urged to start postpartum depression screening and referral programs to identify and help women struggling with their mental health. Developing effective programs and procedures for screening can be challenging. A new quality improvement (QI) initiative by Cedars-Sinai investigators in the Department of Obstetrics and Gynecology identified nurse training and education as keys to successfully examining women in their care.
“Our research also showed that it was helpful to design screening as part of the medical center’s commitment to family well-being, as opposed to simply using the term ‘depression.’ challenging the transition to normalcy for parents with Accortt, a clinical psychologist and assistant professor in the department of obstetrics and gynecology.
Initiative, Implementing an Inpatient Postpartum Depression Screening, Education and Referral Program: A Quality Improvement Initiative, is published in American Journal of Obstetrics and Gynecology-Maternal-Fetal Medicine,
Nurses are often on the front lines of screening programs for postpartum depression, but nursing schools rarely require training in mental health screening or education. Reviewing data involving more than 19,500 women who gave birth at Cedars-Sinai allowed investigators to evaluate the benefits of additional training for nurses who were accused of reaching new mothers for depression.
Sarah Kilpatrick, PhD, MD, senior author of the QI study, and the helping hand of the Los Angeles Chair in Obstetrics, said, “We recognized that we needed to do a better job identifying patients at risk before they could go home from the hospital. ” Gynecology at Cedars-Sinai.
“We learned that this is a complex process that requires dedicated collaboration between nurses, physicians and information technology personnel in order for the system to work. Our framework must be replicated in other hospitals, thus providing even more families. Helps to recognize and better manage postpartum depression,” Kilpatrick said.
An important tool for evaluating a patient for postpartum depression is a specialized questionnaire designed to identify the presence and severity of the mood disorder. Since many nurses called upon a patient to administer the questionnaire within two days of giving birth, there was concern about doing it correctly, an important quality improvement measure was training in service; Nurses watch as a clinical psychologist performs the procedure with a staff member taking on the role of the patient.
If the results of a new mom’s questionnaire show that she needs help before leaving the hospital, an appointment with a social worker may be scheduled.
“The social worker begins with a caring, non-judgmental, listening ear and provides support and resources based on the needs of the patient. If the woman seems unstable and needs a full psychological evaluation, she may psychiatry. Otherwise, she can provide a referral to our reproductive psychology program or our patient navigator, who can help connect her to care in the community,” Accortt said.
The postpartum depression screening program at Cedars-Sinai has been expanded to include outpatient follow-up. A screening initiative for women who have experienced stillbirth or who are in the obstetric intensive care unit has also been implemented.
“If we care about the mental health of our patients, screening should be made routine, like we screen pregnant patients for diabetes. It should be done in such a way that patients are able to answer questions correctly. feel comfortable, and should be followed consistently—once they leave us, patients at risk of postpartum depression,” Kilpatrick said.
Acort, EE, and others. (2022) Implementing an inpatient postpartum depression screening, education and referral program: a quality improvement initiative. American Journal of Obstetrics and Gynecology-Maternal-Fetal Medicine. doi.org/10.1016/j.ajogmf.2022.100581.