Date of Final Presentation
Sara Ahten, DNP, RN, NC-BC
Jane Grassley, PhD, RN, IBCLC
Coordinator/ Chair of DNP Program
Pam Gehrke, EdD, RN
Abstract/ Executive Summary
Problem Description: Postpartum depression (PPD) is a significant public health problem that is potentially disabling and can be life-threatening. It is one of the most common diagnoses for maternal morbidity and mortality, affecting one in ten women in the United States. Currently, there is no universal process for the identification of PPD within the ambulatory clinics in this regional health system caring for obstetrical patients. A quality improvement project was developed and implemented with a pilot group in the ambulatory setting.
Rationale: Without a standard process for screening, patients and their newborns may be at increased risk for detrimental consequences of PPD. The goal is to improve knowledge of a validated, evidence-based perinatal postpartum depression screening tool, and improve screening for postpartum depression with the tool at patient’s comprehensive post-birth appointments.
Interventions: Following a detailed literature review, best practice interventions were implemented. The project sites postpartum depression screening (PPDS) tool was updated to the Edinburgh Postnatal Depression Scale (EPDS). Education was developed and presented regarding the project aims. Success of the interventions were measured with a postpartum depression knowledge questionnaire, an ambulatory EPDS guideline training assessment, chart audits, and an ambulatory EPDS project Evaluation.
Results: The pre- and post- assessments with the postpartum depression knowledge questionnaire indicated an overall knowledge increase of 11.4% regarding the EPDS, effects of PPD on mother and baby, and local PPD statistics. By the end of the specified project period 100% of the qualified patients were being screened at the recommended time with the validated evidenced-based EPDS; the screening for PPD improvement rate increased overall by 37%.
Virtual education was received positively with recommendations to continue rounding for inperson onsite project management support. There was a realization to the participants that PPD is more prevalent locally. The project evaluation highlighted the recommendations for more mental health providers that are accessible to this population.
Interpretation: In the current setting, education related to PPD increased the participants confidence in screening. The screening rate for PPD improved during the project from 63.1% to 100%. Additional goals were realized in that a standard approach with the EPDS is now part of the project sites practice and staff are trained in the use of the EPDS.
Conclusion: Statistics and evidence continues to evolve as it relates to PPD and the overall public health impact. The CDC updated national PPD statistics for women from affecting one in ten to affecting one in eight since initiation of this project. The quality improvement project was successful in improving knowledge and increasing postpartum screening rates within an ambulatory setting in a health system in the northwestern United States. It is recommended to continue to implement use of the EPDS with education and knowledge validation throughout the health system as evidence states the continued focused efforts will lead to improved maternal-child health outcomes.
Ketchum, Debbie, "Deploying a Validated Postnatal Depression Screening Tool & Guideline to Improve Evidence Based Screening for Postpartum Depression in Ambulatory Care" (2022). Doctor of Nursing Practice Projects. 47.