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2021 prov rn wa; 2021 prov rn poster; washington; spokane
Background: Postpartum depression (PPD) is correlated with worsened maternal and infant health outcomes, and an estimated10-20% of women experience this condition after giving birth. Universal depression screening for PPD in maternity and well-child appointments is the standard of care. However, PPD screening is not well-integrated into outpatient lactation visits which assist new moms with difficulties breastfeeding. To address this gap, routine PPD screening and education was implemented in an outpatient lactation clinic servicing postpartum women in Eastern Washington. Purpose: The purpose of this quality improvement project was to implement the use of PPD screening in a lactation clinic to increase appropriate maternal mental health referrals and enhance provider perception of the clinical need for PPD education in the lactation clinic setting. Methods: Lactation consultants working at a single outpatient clinic servicing postpartum women in Eastern Washington were invited via email to complete a pre-intervention survey on knowledge and confidence in screening and intervening for PPD symptoms in early 2021. Consultants then attended a training session offering information on how to screen for, provide education about, and appropriately refer patients for suspected PPD. The lactation consultants were then requested to incorporate a PPD screen on every patient receiving care in the clinic for a four-week period and to track on a sheet of paper the number of patients: presenting for an appointment, receiving PPD screen, receiving education on PPD, and receiving a referral for potential PPD. At the end of the four-week intervention, consultants were invited to repeat the initial survey. Data was collected and analyzed using descriptive statistics to quantify the providers’ perceptions of PPD before and after the intervention. Open-ended survey items were analyzed using content analysis. Results: 62 of 64 patients were screened during the data collection period meaning 96.9% of patients who attended the lactation clinic received screening for PPD. 90.6% of patients received PPD education, and 100% of patients who were screened were referred correctly for PPD. 14% of patients who were screened received a referral. There were no statistically significant differences in the pre and post-test in the perception of the lactation consultants. Content analysis revealed barriers to PPD screening and education were reduced following the training session, but lack of time was still seen as a barrier.
Conclusion: Incorporating PPD screening and education into the standard of care provided at lactation consultations is another avenue to offer women resources and support needed to cope with symptoms of PPD. In addition, the integration and normalization of this conversation during lactation visits may help reduce the negative stigma surrounding mental health conditions for vulnerable populations such as new mothers. Implications for Practice: This quality improvement project shows that lactation consultants can incorporate PPD screening and education into their practice to improve maternal care. Findings from this project may justify a permanent change to workflow in this clinic to continue routine PPD screening and educating. Future work should be done to advocate for similar lactation clinics to consider adopting this practice as well.
Conference / Event Name
2021 Providence RN Conference
Goebel, Jill and Ramirez, Jeff, "Postpartum Depression Screening to Improve Maternal Outcomes" (2021). View all. 23.