An Electronic Approach to Postpartum Depression Screening in the Postdischarge Neonatal Clinic

Abstract

To improve recognition of postpartum depression in mothers of infants who were in the NICU through the use of a screening tool in the electronic medical record. Cook Children's Medical Center recognized that the current process for identifying mothers at risk for postpartum depression in the NICU Graduate Early Support and Care Transition (NEST) clinic was insufficient to safely meet the needs of families. After reviewing the literature and determining the best evidence for Postpartum Depression Scale use, Cook Children’s opted to implement the Edinburgh Postnatal Depression Scale in the NEST clinic when the infant was 2 months of age. To avoid the barriers identified by paper-based screening, the decision was made to pilot an electronic version of the Edinburg Postnatal Depression Scale with the use of clinical decision support. The NICU team, working with key stakeholders, noticed that they would have the best chance of success with initial implementation of the assessment at the 2-month postnatal appointment. To begin electronic screening of women for postpartum depression at specific intervals and during the infants’ follow-up pediatrician visits. After electronic documentation of the patient’s score, EPIC functionality will generate a message to the referring obstetrician and pediatrician of the score and any resources provided to the family or interventions performed. This additional referral process allows for continued follow up for the infant and mother. This screening will take place in the NEST clinic and will be included in the infant’s electronic medical record to allow for proper follow up and knowledge sharing among medical providers. Outcomes and evaluation of the process occur monthly, with use of data analytics to evaluate whether all patients received their screening, how many patients had a positive screen, and how many of the positive screens received appropriate follow up. Through a standardized process, nurses can facilitate the process whereby women receive postpartum depression screening and ensure that they receive the appropriate resources and follow up to assist the patient in obtaining the support she needs to safely care for herself and her infant.