Implementing a Safety Bundle to Improve Screening and Care for Perinatal Mood and Anxiety Disorders

Abstract

Objective: To improve screening and care of individuals with perinatal mood and anxiety disorders (PMAD) through the implementation of a perinatal mental health safety bundle.

Design: Rapid-cycle quality improvement model using four plan-do-study-act cycles over the course of 90 days. Individuals between 28 and 32 weeks gestation and at their 6-week postpartum follow-up visit were screened and offered stage-based care for PMAD.

Setting/local problem: At baseline, only 15% of clients of a suburban, private-practice women's health clinic were receiving PMAD screening with a validated tool, and the site lacked standardized PMAD care practices among health care providers.

Participants: Health care providers (n = 2), staff (n = 4), and eligible patients (n = 78) at a private-practice women's health clinic.

Intervention/measurements: A screening, brief intervention, referral, and treatment/follow-up (SBIRT) model was used to screen eligible patients, provide treatment options, and appropriately refer for follow-up to mental health services. Team engagement occurred via weekly meetings. Measurements included pre-post maternal and team engagement survey results, biweekly chart review, and run chart analysis.

Results: Effective PMAD screening and right care were achieved for 85% of eligible individuals; this included receiving screening, referral to treatment, a scheduled mental health appointment, and clinic follow-up to ensure mental health care uptake.

Conclusion: Use of the SBIRT model to implement a safety bundle may contribute to improved mental health outcomes for individuals receiving perinatal care in a private-practice outpatient health care setting. Education and engagement among clinicians, staff, and patients are key to successful implementation of a safety bundle.

Keywords: PMAD; SBIRT; depression; perinatal mood and anxiety disorders; postpartum depression; quality improvement; safety bundle.