A Perinatal Depression Safety Bundle to Enhance Outpatient Screening & Referral

Abstract

Problem: The American College of Obstetricians and Gynecologists recommends screening women for depression at least once during the perinatal period and during each postpartum visit using a validated screening tool. Despite this, an outpatient maternity mobile unit predominantly serving immigrant women from racial and ethnic minority groups lacked a standardized perinatal depression screening protocol. Purpose: The purpose of this quality improvement project was to implement a perinatal depression safety bundle to correctly screen and refer 100% of eligible patients. Methods: The safety bundle, compromised of a screening algorithm, the Edinburgh Postnatal Depression Scale (EPDS) in multiple languages, patient education, community resources, and referral lists was implemented over a 15-week period. Screening eligibility criteria include obstetric patients 28-32 weeks gestation and 6-8 weeks postpartum not previously screened within those periods. The medical assistant administered the screening on arrival to the clinic and the EPDS was completed independently by patients unless literacy barriers existed. The clinician reviewed the score and risk factors and initiated interventions based on the screening algorithm. Interventions included a combination of patient education, pharmacologic therapy, referral, and/or community resources. Weekly chart audits were conducted to track the number of patients eligible, screened, and interventions received. Results: 101 eligible patients were screened with an increase in the mean screening compliance rate from 17.8% to 71.3%. 13 patients had a positive EPDS screen with 58.8% referred to mental health services. Overall algorithm adherence, measured by appropriate documentation of screening, patient education, and referral, increased from a mean of 14% to 38.6%. Conclusions: Findings suggest that implementing a screening protocol and safety bundle with patient and clinician resources in the outpatient maternity setting can improve the identification and appropriate management of perinatal depression.