740 - Early Identification of Maternal Postpartum Depression: A Quality Improvement Initiative in the Neonatal Intensive Care Unit
Sunday, April 30, 2023
3:30 PM – 6:00 PM ET
Poster Number: 740 Publication Number: 740.343
Hannah N. Fugate, Madigan Army Medical Center, Puyallup, WA, United States; Catlyn Blanchard, Madigan Army Medical Center, Fircrest, WA, United States; Bryan R. Williams, Uniformed Services University of the Health Sciences, Graham, WA, United States
Resident Physician Madigan Army Medical Center Puyallup, Washington, United States
Background: Maternal postpartum depression (PPD) has significant health impacts including relationship issues, poor health, and increased risk of suicide/homicide. Infants also suffer as maternal PPD is associated with cognitive delay, behavioral problems, and avoidant attachment.1 Risk factors for PPD include a history of depression, multiparity, low socioeconomic status, low social support, high-risk pregnancy (including those with emergency deliveries), postpartum complications, and mothers of infants < 1500g. The CDC estimates that 1 in 8 women (12.5%) experience PPD,2 but research3 suggests higher rates of PPD, up to 40%, in mothers with an infant requiring prolonged NICU care. Objective: The aim is to reduce the time to first maternal postpartum depression screen to < 10 days for infants born at Madigan Army Medical Center (MAMC) by September 2022 for infants admitted to the NICU with prolonged hospitalization by the implementation of a standardized protocol. Design/Methods: A retrospective review identified the baseline and a root causes analysis highlighted barriers to successful maternal PPD screening of mothers with infants in the NICU. A protocol utilizing Edinburgh Postnatal Depression Screens (EPDS) to screen at-risk mothers for PPD was developed for NICU mothers. Inclusion criteria included inborn infants at MAMC with hospital stay >7 days. Data analysis included demographic data, quality metrics, and post implementation data for analysis. Since implementation, the project has undergone 2 additional PDSA cycles. Results: The primary metric of time to first maternal screen has decreased from 68 to 8 postnatal days since the project's initiation. The range has decreased from 3 to 311 postnatal days (pre-implementation) to 7-8 days (post-implementation). Compliance with the screening protocol has been 100% since the implementation.
Conclusion(s): Mothers with critically ill infants are at significant risk of PPD. These mothers often go under-treated and undiagnosed as they and their medical team focus on supporting and caring for their ill infant. At MAMC, the implementation of a standardized protocol for PPD screening has reduced the time to the first screening with statistical significance. We hope to show with further analysis that earlier screening reduced the NICU's mental health burden.
