Improving Postpartum Depression Screening in the NICU: Partnering with Students to Improve Outreach

Abstract

Infants born to mothers with postpartum depression (PPD) are at risk for adverse developmental outcomes. Mothers of premature infants are 40% more likely to develop PPD when compared with the general population. Current published studies on implementing PPD screening in the Neonatal Intensive Care Unit (NICU) do not comply with the American Academy of Pediatrics (AAP) guideline, which recommends multiple screening points in the first year postpartum and includes partner screening. Our team implemented PPD screening that follows the AAP guideline and includes partner screening for all parents of infants admitted to our NICU beyond 2 weeks of age.

Methods: The Institute For Healthcare Improvement Model for Improvement was the framework for this project. Our initial intervention bundle included provider education, standardized identification of parents to be screened, and bedside screening performed by the nurse with social work follow-up. This intervention transitioned to weekly screening by phone by health professional students and the use of the electronic medical record for notification of team members of screening results.

Results: Under the current process, 53% of qualifying parents are screened appropriately. Of the parents screened, 23% had a positive Patient Health Questionnaire-9 requiring referral for mental health services.

Conclusions: Implementing a PPD screening program that complies with the AAP standard is feasible within a Level 4 NICU. Partnering with health professional students greatly improved our ability to screen parents consistently. Given the high percentage of parents with PPD uncovered with appropriate screening, this type of program has a clear need within the NICU.

Fig. 1.

Key driver diagram.

Fig. 2.

Process maps for implementation of PPD screening in the NICU. A, Process map for the initial process, utilizing the bedside nurse. B, Process map for the current process, utilizing the health professional students.

Fig. 3.

P-Chart: Legend: 1: Standardized tracking via shared spreadsheet; 2: Second parents assessed in addition to birth parent; 3: NICU Psychologist contact information given to all parents; 4: PHQ-9 screening for all qualifying families; 5: Back to 1 volunteer calling families; 6: Results of screen communicated via EMR 7: Screening calls timed to determine whether adding additional screens possible.