Adaptation of a Best Practice Model for Recognition and Treatment of Postpartum Depression in a Private Obstetrics Practice

Abstract

Rates and negative consequesnces associated with postpartum depression (PPD) are well documented and remain high (Pearlstein, 2008). Few guidelines for nurses exist. Research indicates that depression is twice as commmon in women as in men (Beck, 2008; peralstein, 2008). The postpartum period, defined as the year after delivery, may be marred by negative feelings, including loss of self-esteem, disassociation with mothering and poor infant attachment. A meta-analysis by Bennett and colleagues put the incidence of PPD at 10-20% of all deliveries, with 13% the most frequently quoted rate (Bennett, Einarson, Taddio et al, 2004). The purpose of this evidence-based project was to determine whether a best practice model developed by the Registered Nurses Association of Ontario (RNAO) in Canada could be used to improve identification and management of women receiving postpartum care in a private obstetrics practice in the United States. This evidence-based practice (EBP) guideline is operationalized by use of the Edinburgh Postnatal Depression Scale (EPDS). Secondary aims were to achieve 100% compliance in screening postpartum patients for depression, improve staff documentation and commuication about PPD and establish an on-going protocol for screening and management. Using the Stetler Model of Resarch Utilization (2001), the researcher conducted two retrospective chart reviews over a six-week period, one of 170 postpartum patients prior to the initiation of the RNAO Guidelines and one of 168 patients post guidelines administration. Prior to initiation, staff education on the guidelines, along with appropriate provider management, was conducted, patient education materials were developed and a method of patient follow-up was developed. Upon initiation of the RNAO guidelines, 96% of postpartum patients were screened by the EPDS. Identification of patients at risk for PPD increased from 4.7% to 11% following implementation of the guidelines. Using Yates Chi square analysis, initiation of the RNAO, as operationalized by the EPDS, resulted in identification of more women at risk for postpartum depression. Nursing staff and provider documentation improved, and 100% of patients identified at risk had a follow-up plan. Initiaiton of the RNAO guidelines may positively influence the identification and management of patients at risk for PPD in a private obstetrics practice. The electronic medical record may be a confounder due to automatic defaults that were inconsistently used by providers. Due to the sensitive nature of the subject, it was noted that nursing staff needed ongoing support and education to feel comfortable with thier new responsibilities. Sustainability will involve incorporating ongoing use of the EPDS, integrating its use into chart audits, and providing ongoing education for nursing staff and providers.