123 - Beyond Baby Blues: Improving Postnatal Depression Screening in the Outpatient General Pediatrics Clinic

Studies show postpartum depression (PPD) affects at least 10% of women. Many depressed mothers do not get proper treatment, with long term effects on the family unit. An audit was performed in our pediatric clinic that demonstrated Edinburgh Postnatal Depression Screeners (EPDS) were documented at 67% of requisite well visits. Failing to identify mothers at risk or suffering from postnatal depression leads to delays in treatment, which can negatively impact family dynamics and the care of the infant.








Objective:

Increase median EPDS completion rates at 1, 2, 4, and 6 months to 80% by October, 2022.








Design/Methods:

We used a process outcome measure to evaluate whether an EPDS score was documented in the patient’s chart. Baseline data identified a median of 67% documentation. We altered the process for inputting screeners and provided educational interventions that instructed staff on the process of documentation and importance of completing the screener. Data was collected from the Epic EPDS flowsheet into Tableau.

Results:

Our first two PDSA cycles showed improvement to a median of 79%. Documentation dropped to near baseline in August 2021 but improved after PDSA 3. After PDSA 4, we saw our longest period of improvement from October to March of 2022. We had a decrease below our new median in spring of 2022.  We ended the 20-month study with a median of 80%.

Conclusion(s):

Our first two cycles showed improvement to near goal. We attribute these results to residents having a visual reminder to review and document screeners.  PDSA 2 likely addressed knowledge gaps in the practical utilization of Epic as a new EMR system and taught staff how to input scores into the flowsheet. The drop in rates in August 2021 could be secondary to an influx of new providers. Our residency-wide quiz (PDSA 3) and the second, more targeted lecture (PDSA 4), resulted in our period of most significant improvement. However, sustainability proved to be a challenge, with a decrease below our new median in spring of 2022 of uncertain significance.  We ended by meeting our goal with a final median of 80%. Overall, educational strategies proved effective, but lacked long-term sustainability, especially with the frequent turnover typical of resident clinics. The bi-annual online training module implemented at the end of the study (PDSA 6) was meant to standardize the onboarding process. In coming months, sceeners will be completed via Ipad prior to the start of the visit, which will eliminate provider documentation errors. Thus, future improvement efforts could be aimed at interpretation and utilization of EPDS results.