Development and Implementation of a Postpartum Depression Screening Program in the NICU

2020 ◽  
Vol 39 (2) ◽  
pp. 75-82
Author(s):  
Angela Taylor Vaughn ◽  
Gwendolyn L. Hooper
Keyword(s):  
Data Analysis ◽  
Postpartum Depression ◽  
Screening Tool ◽  
Screening Program ◽  
Routine Screening ◽  
Diagnostic Evaluation ◽  
Depression Screening ◽  
National Organizations

Postpartum depression (PPD) is higher among NICU mothers compared to mothers without infants in the NICU. Routine screening improves early PPD identification and treatment for mothers. Key national women and infant organizations endorse facility-based policies that address PPD screening. In addition to PPD screening, the key national organizations recommend facilities providing care to women and infants develop a method of referral for maternal PPD evaluation, treatment, and follow-up. Due to the timing, onset, and maternal predisposition to PPD, the NICU is a prime setting for PPD screening. Despite recommendations, PPD screening is not routine in the NICU. This article describes the development and assessment of a PPD screening program implemented in the NICU. Data analysis of 30 NICU mothers evaluated the risk of PPD based on screening tool scores, maternal diagnostic evaluation compliance, and documentation of maternal follow-up with designated NICU staff.

Depression Screening in a Primary Care Practice in Oregon

2013 ◽  
Vol 6 (1) ◽  
pp. 13-18
Author(s):  
Caron L. Strong
Keyword(s):  
Primary Care ◽  
Screening Tool ◽  
Task Force ◽  
Pilot Project ◽  
Routine Screening ◽  
Depression Screening ◽  
Care Practice ◽  
Improvement Project ◽  
Health Maintenance

Depression is a serious and common mental illness in primary care. Regardless of the improvements in depression management, depression in many patients is still unrecognized. Routine screening for depression among adults in primary care is recommended by the U.S Preventive Service Task Force, as long as healthcare organizations are equipped with staff-assisted depression support systems. The purpose of this dissemination pilot project was to evaluate the routine use of the PHQ-9, a depression screening tool, among adult patients presenting for annual health maintenance examinations. Additionally, increasing follow-up visits among patients with positive depression screens was also investigated. The three-week practice quality improvement project was successful in implementing a routine depression screening policy. Among patients scheduled for their annual health maintenance examination, 94% were screened for depression. All patients who self-identified as at risk for depression were screened with the PHQ-9. Among patients with positive screens, the majority were invited for follow-up care during the study. As a result of the pilot, this clinic now exclusively uses the PHQ-9 depression screening tool. Furthermore, they modified their annual health maintenance examination policy to include routine screening for depression.

scholarly journals Postpartum depression screening: are we doing a competent job?

2019 ◽  
Vol 8 (4) ◽  
pp. e000616 ◽  
Author(s):  
Sathyanarayan Sudhanthar ◽  
Zile-e-huma Sheikh ◽  
Kripa Thakur
Keyword(s):  
Postpartum Depression ◽  
Local Community ◽  
Screening Tool ◽  
Stakeholder Participation ◽  
Depression Scale ◽  
First Year ◽  
Educational Strategies ◽  
American Academy Of Pediatrics ◽  
Pdsa Cycle

Postpartum depression (PPD) is one of the most common and severe postpartum morbidity, affecting 10%–20% of mothers within the first year of childbirth. The adverse effects of PPD, namely, prevention of mother-baby bonding and early cessation of breastfeeding, adversely affects infant growth and brain development. Studies have found that up to 50% of women with PPD go undiagnosed. Despite the American Academy of Pediatrics (AAP) recommendations, only a small percentage of paediatricians are currently screening for PPD. This project aimed to improve PPD screening using a validated tool to 75% in a primary care inner-city clinic serving a predominantly underserved population as per AAP recommendations. Baseline data for 40 charts of 2-month-old and 4-month-old well-child visits showed no documentation of PPD screening. The screening tool used for this project was the Edinburgh Postpartum Depression Scale (EPDS), which is a validated 10-item screening questionnaire for PPD. Three Plan-Do-Study-Act (PDSA) cycles were implemented involving educational strategies, system-based practice improvement and stakeholder participation. Improvement seen after PDSA cycle 1 was minimal. At the end of cycle 2, 16/50 (33%) charts had documentation of screening using EPDS. At the end of cycle 3, 33/40 (82%) charts had EPDS documentation, an increase of 49% from cycle 2. There were eight in total positive PPD screenings between cycles 2 and 3. These patients were provided counselling support through a social worker and referral services through the local community mental health organisation. We achieved more than our 75% target goal for PPD screening implementation at the residency clinic, thereby increasing residents’ awareness of PPD and the importance of PPD screening. Poststudy follow-up shows that screening was maintained at a higher rate but never reached 100%.

scholarly journals Depression Screening During Pregnancy: Compliance and Effectiveness in a Military Population

2020 ◽  
Author(s):  
Jordan Gisseman ◽  
Tara Fletcher ◽  
Abigail Schmolze ◽  
Devin Cooper ◽  
James Aden ◽  
...  
Keyword(s):  
Postpartum Depression ◽  
Screening Program ◽  
Medical Center ◽  
Demographic Data ◽  
Depression Scale ◽  
Veterans Affairs ◽  
Depression Screening ◽  
Average Risk ◽  
Postpartum Visit ◽  
Military Population

ABSTRACT Introduction Perinatal and postpartum depression are common, affecting 13% to 24% of pregnant women through the first year postpartum. Depression screening is recommended by the American College of Obstetrics and Gynecology as an effective and low-cost intervention to improve patient outcomes; however, no nationwide screening rate is reported in the literature. This study was designed to assess the rate and effectiveness of screening in a major military medical center. Materials and methods Institutional review board (IRB) approval was obtained before beginning the study. The facility where this study was performed has a universal depression screening policy in which all patients should be screened using the Edinburgh Postnatal Depression Scale (EPDS) at the initial obstetric visit, the 28-week visit, and the postpartum visit. The EPDS scores and demographic data were collected by chart review of patients seen between May 2015 and April 2017. Results Ninety-six percent of patients completed EPDS at their first appointment with a mean score of 3.8. At 28 weeks, 60% of patients were screened with a mean score of 3.8, and at the postpartum appointment, 84% were screened with a mean score of 3.5. Veterans Affairs (VA) patients and dependent daughters had significantly higher EPDS scores than active duty women and dependent wives (mean 7.91, 5.78, 3.19, 3.70, P < .0001). Eight-eight percent of patients with scores of ≥12 were offered the appropriate treatment. Conclusions First trimester screening rates are excellent; however, 28-week and postpartum screening rates need improvement. Standardization of clinic screening procedures may be necessary to increase the screening rates. Veterans Affairs patients and dependent daughters have a higher-than-average risk for depression and should be monitored closely. This study demonstrates that a universal postpartum depression screening program is an important part of obstetric care.

Commentary and Integration: Is it Time to Routinely Screen for Depression in Clinical Practice?

2009 ◽  
Author(s):  
James C. Coyne
Keyword(s):  
Screening Program ◽  
Routine Care ◽  
Routine Screening ◽  
Clinical Settings ◽  
Adequate Treatment ◽  
Screening Programs ◽  
Key Issues ◽  
Almost All ◽  
New Evidence

We were pleased we were able to convince such talented authors to contribute chapters to this volume. We hope that their contributions will serve to redefine key issues in the implementation of screening programs for depression in clinical settings. The chapters are quite varied but are notable for their balanced, evidence-based recommendations and skepticism about introducing screening into routine care unless there is a substantial infusion of resources. Taken together, the chapters provide a foundation for critiquing screening programs as they are currently being implemented. Screening has become the most commonly adopted enhancement of care for depression, even if questions can be raised about the fidelity with it is being implemented. Yet, the enthusiasm for screening is not based on the accumulation of compelling new evidence, but rather a reframing of the question of its efficacy, and the evidence is mustered to answer it. The crucial question has shifted from ‘‘Does routine screening improve patient outcomes?’’ to ‘‘Can screening be used to improve outcomes when there is a substantial effort made to ensure adequate treatment and follow up?’’1 This seemingly important difference has been downplayed in endorsements of screening. And yet, stand-alone screening programs are simply not effective in improving the management of depression in primary care (see Chapter 7). Moreover, including screening as a component in more comprehensive enhancements of care may not be necessary to improve outcomes. One can readily find basis in this volume for questioning the wisdom of stand-alone screening initiatives and for raising doubts whether routine screening is acceptable and sustainable in non-mental-health medical settings. I will highlight these points in the context of providing a more general commentary on the preceding chapters. One goal is to alert readers tempted by enthusiasm about screening to some frustrations and disappointments that await them if they proceed with a screening program without additional resources. I acknowledge that I am going beyond the conclusions of many chapters. However, almost all limit endorsement of screening to settings where supports are in place for absorbing the effects of screening and ensuring it has its intended effect. Unfortunately, such settings are far less common than presumed. So, the question becomes, ‘‘What are the implications of routine screening being implemented without such support?’’

The Lung Reporting and Data System (LU-RADS): A Proposal for Computed Tomography Screening

2014 ◽  
Vol 65 (2) ◽  
pp. 121-134 ◽  
Author(s):  
Daria Manos ◽  
Jean M. Seely ◽  
Jana Taylor ◽  
Joy Borgaonkar ◽  
Heidi C. Roberts ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Screening Program ◽  
Positive Outcome ◽  
Data System ◽  
Routine Screening ◽  
Low Grade ◽  
Minimal Risk ◽  
Implementation Challenges ◽  
Risk Of Malignancy

Despite the positive outcome of the recent randomized trial of computed tomography (CT) screening for lung cancer, substantial implementation challenges remain, including the clear reporting of relative risk and suggested workup of screen-detected nodules. Based on current literature, we propose a 6-level Lung-Reporting and Data System (LU-RADS) that classifies screening CTs by the nodule with the highest malignancy risk. As the LU-RADS level increases, the risk of malignancy increases. The LU-RADS level is linked directly to suggested follow-up pathways. Compared with current narrative reporting, this structure should improve communication with patients and clinicians, and provide a data collection framework to facilitate screening program evaluation and radiologist training. In overview, category 1 includes CTs with no nodules and returns the subject to routine screening. Category 2 scans harbor minimal risk, including <5 mm, perifissural, or long-term stable nodules that require no further workup before the next routine screening CT. Category 3 scans contain indeterminate nodules and require CT follow up with the interval dependent on nodule size (small [5-9 mm] or large [≥10 mm] and possibly transient). Category 4 scans are suspicious and are subdivided into 4A, low risk of malignancy; 4B, likely low-grade adenocarcinoma; and 4C, likely malignant. The 4B and 4C nodules have a high likelihood of neoplasm simply based on screening CT features, even if positron emission tomography, needle biopsy, and/or bronchoscopy are negative. Category 5 nodules demonstrate frankly malignant behavior on screening CT, and category 6 scans contain tissue-proven malignancies.

Implementation of Postpartum Depression Screening Tool in Pediatric Clinic: A Resident QI Project

2011 ◽  
Vol 11 (4) ◽  
pp. e10-e11
Author(s):  
Alicia Idler ◽  
Kaylan R. Parashette ◽  
Sindhuja Harsha Vardhan ◽  
Amanda D. Osta
Keyword(s):  
Postpartum Depression ◽  
Screening Tool ◽  
Depression Screening ◽  
Pediatric Clinic

Mothersʼ Perspectives on Follow-up for Postpartum Depression Screening in Primary Care

2019 ◽  
Vol 40 (2) ◽  
pp. 139-143 ◽  
Author(s):  
Hannah R. Canty ◽  
Alicia Sauter ◽  
Katharine Zuckerman ◽  
Maritza Cobian ◽  
Tamara Grigsby
Keyword(s):  
Primary Care ◽  
Postpartum Depression ◽  
Depression Screening

Your Job: Postpartum Depression Screening

2007 ◽  
Vol 41 (3) ◽  
pp. 28
Author(s):  
MICHAEL S. JELLINEK
Keyword(s):  
Postpartum Depression ◽  
Depression Screening
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