Nurs Womens Health. 2023 Dec 5:S1751-4851(23)00224-6. doi: 10.1016/j.nwh.2023.11.003. Online ahead of print.

ABSTRACT

OBJECTIVE: To improve screening for perinatal mood and anxiety disorders (PMAD) and follow-up care while balancing team workload.

DESIGN: Four rapid plan-do-study-act cycles were implemented over 8 weeks.

SETTING/LOCAL PROBLEM: At baseline, only 2% of patients with PMAD were identified at a rural obstetric clinic, and none (n = 0 of 50) received screening with a validated tool. Of the 12 patients who had a current or prior history of PMAD, 92% (n = 11) were not screened for self-harm, and 67% (n = 8) received no referral. The clinic had no standardized care for PMAD.

PARTICIPANTS: Patients (n = 253) screened at initial pregnancy intake, early in the third trimester, and at the 6-week postpartum visit.

INTERVENTION/MEASUREMENTS: Following the screening, brief intervention, and referral to treatment model, patients were screened using the Edinburgh Postnatal Depression Scale, and brief intervention and referral to treatment were used with a point-of-care checklist. Data were collected three times weekly for run chart analysis, and team surveys measured workload.

RESULTS: At the end of 8 weeks, effective screening for PMAD and follow-up care were achieved for 98% of patients and included screening, education, shared decision-making for management, referral, and clinic and phone follow-up to support mental health care uptake.

CONCLUSIONS: Standardizing screening and follow-up care can increase identification of PMAD and increase uptake of mental health care. For sustainability, a decision aid can streamline patient-provider communication and reduce visit length.

PMID:38065223 | DOI:10.1016/j.nwh.2023.11.003