Addressing Postpartum Depression in the Mother-Baby Unit

Addressing Postpartum Depression in the Mother-Baby Unit

Identification of a Quality-Related Problem

The quality-related problem I have identified in the Mother/Baby unit is the occurrence of postpartum depression. Postpartum depression is a serious mental health concern that impacts up to 15% of women after giving birth (O’Hara & McCabe, 2013). This condition can have significant negative effects on maternal-infant bonding and child development if not properly addressed. The Joint Commission has recognized postpartum depression as an important quality issue for maternal care and provides recommendations for screening and follow-up (The Joint Commission, 2015).

Postpartum depression is diagnosed when a woman experiences a major depressive episode within 4 to 6 weeks after delivery (O’Hara & McCabe, 2013). Common symptoms include sadness, fatigue, changes in appetite and sleep patterns, guilt, worthlessness, difficulty concentrating and making decisions, and suicidal ideation. Postpartum depression differs from “baby blues,” which consists of milder depressive symptoms that resolve within two weeks after birth. Postpartum depression can develop rapidly or have a gradual onset over the first three months postpartum. It is critical that screening continues throughout the postpartum period to identify emerging cases.

Several risk factors may predispose women to postpartum depression. A prior history of depression or anxiety greatly increases risk. Women who experienced depression during pregnancy had traumatic births, have inadequate social support, or have relationship problems are also at higher risk (O’Hara & McCabe, 2013). Lower socioeconomic status, unintended pregnancy, and infant health issues can contribute as well. Screening should focus on women with any of these risk factors, but universal screening is recommended as cases can occur without predictors.

Best Practices and Guidelines

The U.S. Preventive Services Task Force recommends that all pregnant and postpartum women be screened for depression (Siu et al., 2016). Screening should occur at least once during pregnancy and again within the first few weeks postpartum. Validated screening tools such as the Edinburgh Postnatal Depression Scale or the Patient Health Questionnaire-9 should be utilized. The Edinburgh scale includes ten items assessing mood, guilt, anxiety, and suicidal thoughts over the past seven days (O’Hara & McCabe, 2013). Scores range from 0-30, with higher scores indicating more severe symptoms. The PHQ-9 measures the frequency of depressive symptoms corresponding to diagnostic criteria. Women with positive screens should receive further evaluation with a complete biopsychosocial assessment and be connected with appropriate mental health resources.

For women diagnosed with postpartum depression, cognitive behavioral therapy or antidepressant medications are considered first-line treatments (O’Hara & McCabe, 2013). Cognitive behavioral therapy focuses on identifying and modifying negative thought patterns, behaviors, and interactions that contribute to depressive symptoms. Therapy can be done individually or in a group setting. Selective serotonin reuptake inhibitor (SSRI) medications like sertraline and paroxetine are commonly prescribed, as they are relatively safe for breastfeeding mothers. Close follow-up is essential to monitor symptoms and medication side effects. Providers should also assess mother-infant bonding and offer guidance on healthy interactions. Partner involvement in care and peer support groups is also beneficial.

The American College of Obstetricians and Gynecologists (2018) recommends beginning with psychotherapy for mild to moderate depression severity. Medications can be considered as an adjunct treatment or for more severe symptoms. Women with suicidal ideation, psychotic features, or an inability to function require urgent referral to mental health services. Hospitalization may be necessary for safety in extreme cases. For women with chronic depression who require extended treatment, providers should ensure access to behavioral health services during the transition to outpatient postpartum care (The American College of Obstetricians and Gynecologists, 2018). Ongoing medication and therapy management are critical to prevent relapse. Care coordination, home visits, and peer support are also helpful for high-risk mothers with psychosocial needs.

Financial Impact

Postpartum depression is estimated to have an economic burden of $14.2 billion annually in the United States, primarily due to detrimental impacts on child development (Luca et al., 2019). Costs include expenses related to mental healthcare for mothers, early intervention services for children, and lost productivity. Hospital readmissions related to postpartum complications also contribute to costs.

Untreated postpartum depression can negatively impact patient satisfaction. Women may avoid or delay seeking care in the future due to unresolved mental health issues stemming from childbirth. Additionally, poor maternal-infant bonding can increase pediatric costs over the long term if developmental and behavioral concerns emerge. On an organizational level, postpartum depression screening and management initiatives require an investment of resources and staff time. However, identifying cases early and connecting women with effective treatment can improve outcomes and reduce expensive acute care utilization. There are also potential cost savings from decreasing adverse events related to impaired maternal judgment and avoidance of medical care (Farr et al., 2014). Overall, the long-term benefits of properly addressing this condition appear to outweigh the costs of screening programs.

Implementation Using PDSA Model

To address postpartum depression screening and follow-up on the Mother/Baby unit, I would utilize the IHI’s Plan-Do-Study-Act (PDSA) model:

Plan – A multidisciplinary team including nurses, social workers, mental health professionals, and unit leadership will be assembled. The best practices and plan changes to the postpartum clinical pathway will be reviewed to integrate validated depression screening tools and prompts for follow-up of positive screens. Further, policies for referral and escalation of care will then be developed. The required staff education on depression screening, treatment options, community resources, and discharge planning will also be created.

Do – The revised postpartum pathway will be implemented with a small group of patients over a two-week period, and nurses will be trained in administering and scoring screening tools. Social workers will receive training on mental health resources and care coordination. Providers will be educated on treatment options and follow-up protocols.

Study – After the two-week pilot, results will be evaluated, and staff feedback will be gathered via surveys and focus groups. Screening compliance, referral and treatment accuracy, continuity of care, and staff perspectives will be assessed. Moreover, data will be analyzed to identify gaps and opportunities for improvement.

Act – The screening and referral process will be modified as needed based on evaluation data. Successful components will be expanded to the entire Mother/Baby unit. Additional PDSA cycles focusing on individual workflow steps will further refine the clinical pathway.

As the initiative expands, interdisciplinary coordination will be crucial. Psychiatric nurse practitioners can provide medication management with OB/GYN oversight. Social workers will need dedicated time for discharge planning and connecting families to community resources. Notably, clear hand-offs are essential to ensure women follow through with treatment plans after discharge. Ongoing training and competency assessments will help sustain changes.

Quality Improvement Measures

To track this quality improvement initiative, I would monitor the percentage of postpartum women screened for depression prior to discharge, time the initial screening from delivery, the percentage of women with positive screens who received a mental health referral, the percentage of referred women who establish care with a mental health provider, the accuracy of depression severity classification, the appropriateness of treatment plans based on symptom severity, the completion of a safety assessment for women expressing suicidal ideation, the accuracy of screening documentation in the electronic health record and the postpartum readmission rates for depression. These process measures will indicate whether the new screening steps are being reliably performed and resulting in appropriate follow-up actions. The outcome metric of postpartum readmissions could demonstrate improvement over time if more women are effectively connected to treatment after discharge.

Useful Quality Improvement Tools

Run charts plotted over time are a straightforward way to track whether process and outcome measures are improving with the implementation of depression screening. For example, a run chart displaying the percentage of women screened each week would clearly demonstrate changes. Furthermore, a Pareto chart would help identify the most common barriers to successful screening and referral. By ranking the various reasons why the process fails, we can focus our improvement efforts on the vital few root causes. Also, a flowchart outlining the new screening, treatment, and follow-up process would orient staff. It would also reveal any inefficient steps or gaps in care coordination. Lastly, control charts could help differentiate special versus common cause variation as the rates of screening compliance, appropriate referral, and readmissions are monitored. This would pinpoint whether changes require modification of the system or process rather than individual personnel.

Leadership Model

To lead this initiative, I would apply the principles of transformational leadership. Transformational leaders inspire change by articulating a compelling vision and linking it to shared goals and values (Bass & Riggio, 2006). For this project, I would emphasize how properly addressing postpartum depression enables us to achieve our mission of holistic maternal-child care. Transformational leaders also focus on individual needs and empowering staff. I would solicit feedback from nurses, social workers, providers, and other stakeholders to incorporate their perspectives in designing the screening procedures and protocols. By valuing their input, I can gain buy-in to facilitate successful implementation.

During the rollout, challenges and resistance are likely to occur with practice changes. The tenets of transformational leadership help motivate teams through obstacles. First, I would continue reiterating the meaningful purpose behind this initiative – improving the lives of mothers and babies by promoting maternal mental health. Next, I would encourage staff to think innovatively and develop their own solutions to problems. When issues arise with workflow or consistency, I would view it as an opportunity for shared learning. My confidence in the team’s abilities would inspire them to persist despite hardships. Celebrating small wins and milestones would further empower staff and build momentum. With a transformational leadership approach, the overarching vision continues, moving the team in a unified direction during times of difficulty.

Conclusion

Postpartum depression is a major maternal health concern that can profoundly impact families if unaddressed. Implementing routine screening and follow-up aligns with evidence-based recommendations to improve quality and outcomes. Utilizing PDSA cycles and quality improvement tools to design and evaluate the new processes will drive measurable improvements. A transformational leadership style will motivate and unite the interdisciplinary team to successfully execute this meaningful initiative to support new mothers’ well-being. 

References

American College of Obstetricians and Gynecologists. (2018). ACOG committee opinion no. 757: Screening for perinatal depression. Obstetrics & Gynecology, 132(5), e208–e212. https://doi.org/10.1097/AOG.0000000000002927

Bass, B. M., & Riggio, R. E. (2006). Transformational leadership (2nd ed.). Psychology Press.

Farr, S. L., Denk, C. E., Dahms, E. W., & Dietz, P. M. (2014). Evaluating universal education and screening for postpartum depression using population-based data. Journal of Women’s Health, 23(8), 657–663. https://doi.org/10.1089/jwh.2013.4586

Luca, D. L., Garlow, N., Staatz, C., Margiotta, C., & Zivin, K. (2019). Societal costs of untreated perinatal mood and anxiety disorders in Washington. https://www.mathematica-mpr.com/our-publications-and-findings/publications/societal-costs-of-untreated-perinatal-mood-and-anxiety-disorders-in-washington

O’Hara, M. W., & McCabe, J. E. (2013). Postpartum depression: current status and future directions. Annual Review of Clinical Psychology, 9, 379–407. https://doi.org/10.1146/annurev-clinpsy-050212-185612

Siu, A. L., Bibbins-Domingo, K., Grossman, D. C., Baumann, L. C., Davidson, K. W., Ebell, M., García, F. A., Gillman, M., Herzstein, J., Kemper, A. R., Krist, A. H., Kurth, A. E., Owens, D. K., Phillips, W. R., Phipps, M. G., & Pignone, M. P. (2016). Screening for Depression in Adults: U.S. Preventive Services Task Force Recommendation Statement. JAMA, 315(4), 380–387. https://doi.org/10.1001/jama.2015.18392

The Joint Commission. (2015). Detecting and treating maternal depression before it becomes postpartum depression. Quick Safety, 23. https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/quick-safety/quick_safety_issue_23_maternal_depression_6_2_

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In a Microsoft Word document of 5-6 pages formatted in APA style, respond to the following topics related to quality improvement problems.
Identify a quality-related problem on your unit, (unit is Mother/Baby) in your organization, or your practice area that is found on the IHI or Joint Commission websites. Do not use Central Line-associated Bloodstream Infection (CLABSI)) or Catheter-associated Urinary Tract Infections (CAUTI).

Addressing Postpartum Depression in the Mother-Baby Unit

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Describe the best practices or recommended guidelines related to the problem you identified.
Explain the financial impact of this problem on the organization and on the patient.
Describe how you will implement your project using the IHI PDSA model. Describe a project you could implement to address the identified problem using the IHI PDSA model.
Explain the quality improvement measures you could use to track the quality improvement project.
Determine what quality improvement tool or tools would be most useful to help analyze and monitor the problem (e.g., run chart, flow-chart, Pareto chart).
Identify a leadership theory or model that you would use to implement your project.
Support your responses with examples and information from library resources, textbooks and lectures.
On a separate reference page, cite all sources using APA format. Please note that the title and reference pages should not be included in the total page count of your paper. I