IMPLEMENTATION OF A POSTPARTUM DEPRESSION SCREENING TOOL IN A WOMEN’S HEALTH OUTPATIENT CLINIC
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2024
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Abstract
Importance: Postpartum depression (PPD) is a common post-childbirth neuropsychiatric condition. Approximately 20% of women may be affected by PPD in the United States. While the American College of Obstetricians and Gynecologists recommends the use of a validated screening tool for PPD as part of postpartum care, guidelines vary from clinic to clinic depending on protocol, provider knowledge, attitude, or behavior.Methods: A standard of practice change and a post-intervention evaluation were employed. The Edinburgh Postnatal Depression Scale (EPDS) was implemented at the beginning of postpartum visits along with instructions for staff on administration, grading, and documentation. Data was collected by medical record review and interviews. A data abstraction tool was used to evaluate if the results from the EPDS were documented, if care plans were documented, and if follow-up was scheduled. Screening rates were compared two months pre- and post-implementation. Providers were asked about their satisfaction using the EPDS, as well as the benefits of screening and areas for future improvement.
Results: The nonidentified patient records of 26 unique postpartum visits were included in the pre-intervention period, while 44 patient records were included in the post-intervention period. Pre-intervention, 3 out of 26 visits noted diagnoses of postpartum depression (11.5%). None of these visits documented the use of a screening tool. Post-intervention, the EPDS was implemented in 37 out of 44 visits (84.1%). 13.6% of these visits had depression indicated through EPDS scoring and patient interview. Of the patients who had indicated depression, 66.7% had documented treatment in their charts. Providers overall believed that the new protocol has benefits and that there are areas for improvement.
Conclusion: Screening tools can be successfully implemented in coordination with clinical staff, medical assistants, and consideration for workflow. Future projects should consider provider attitudes towards or interpretation of the EPDS and abilities to effectively discuss and treat depression, as well as implementation of different components for the EMR to ensure improvement of documenting screening, treatment, and follow-up.
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Nursing, Edinburgh Postnatal Depression Scale, postpartum depression
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40 pages
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