Purpose for the Program
There are missed opportunities to screen women for postpartum depression and refer them for appropriate follow-up care. This pilot program, Know Before They Go, evaluated the feasibility of establishing a standardized screening and referral process in the immediate postpartum period. We describe how the process was implemented and provide a cost-benefit analysis. Nurse managers can use this information to develop a similar interprofessional program at their institutions to improve patient safety and optimize the level of service they provide women during the postpartum period.
To implement early screening and referral for postpartum depression.
Implementation, Outcomes, and Evaluation
Forty-eight patients consented during their pregnancies to be screened for depression at 12-36 hours after giving birth. Two prelicensure nursing students, who served as research assistants, measured the length of time to distribute, collect, and score the screening results. The nurses reviewed and discussed the results with the patients and documented the findings into the medical record. As per the early screening protocol developed for this pilot, those women who had a positive screening result (more than 12 on the Edinburgh Postnatal Depressive Scale) for severe depression were offered social work and behavioral health consults. When patients in the pilot returned for their 6-week postpartum visits, they were given a survey about their participation in the program.
From a process standpoint, the pilot ran smoothly. Consistent with the literature, 6.25% of women had a positive screening result for major depression. Patients willingly completed the screening test in a timely manner; the response of the various disciplines was prompt; there were no delayed discharges as a result of a positive screening result; and there was support from patients, nurses, and physicians. The cost per patient with a negative screening result was $3.23 and the cost per patient with a positive screening result was $4.98 based on a nurse's salary of $35.00 per hour. As part of the pilot, nurses and physicians were invited to educational sessions on postpartum depression. Outcomes show that screening in the immediate postpartum period is feasible and relatively inexpensive for the department of nursing. One of the three women with a positive screening result sought follow-up mental health treatment while another cited transportation issues as a barrier to treatment.
Implications for Nursing Practice
The Association of Women's Health, Obstetric and Neonatal Nurses believes that nurses are in a key position to assess new mothers for symptoms of depression and provide education and appropriate referral information for the treatment of postpartum depression. Improved marketing, identification of barriers to treatment, and universal implementation are recommendations to improve access to mental health follow-up for this vulnerable population.