ABSTRACT

This quality improvement project demonstrates the effectiveness of standardizing postpartum depression (PPD) screening, intervention, and documentation process across three pediatric clinics within one Midwest health system. PPD can cause unexplained sadness or worthlessness, loss of interest or pleasure, sleep disturbances, and/or suicidal ideation up to one year after childbirth. Only 60% of symptomatic women are diagnosed and only half are treated. The standardized process instructs the healthcare team to administer the Edinburgh Postnatal Depression Scale (EPDS) to mothers at 2-week to six-month well-child visits and obtain consent to document results in her chart. For positive screens, mothers receive an education handout and the obstetric provider is notified. Additional steps for an active suicide plan include in-patient evaluation with a plan for infant care. Adherence to the process was measured by Epic reports of documented EPDS scores and a tracking log of notifying obstetric providers and calling 911. The likelihood of continuing the process was evaluated with the Normalization Measure Development (NoMAD) Questionnaire (RR=70%). Responses on the NoMAD indicate that the healthcare team wants to continue the standardized process. Across all the clinics, from mid-December to mid-April, standardizing the process increased screening from 60% (n=116) to 100% (n=241) and documentation in the mother’s chart from 27.5% (n=53) to 99% (n=239). Most mothers (93%; n=225) screened negative. Adherence to notifying obstetric providers of positive screens (n=16) and calling 911 for active self-harm plans (n=1) was 100%. Standardization improved PPD screening and documentation across three pediatric clinics within one Midwest health system.