Scholarship & Research
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Item Quality improvement project: implementing a standardized postpartum depression screening protocol in an outpatient pediatric setting(Montana State University - Bozeman, College of Nursing, 2024) Leaphart, Kassie Marie; Chairperson, Graduate Committee: Benjamin J. Miller; This is a manuscript style paper that includes co-authored chapters.Background: Postpartum depression (PPD) continues to be a common condition following childbirth affecting 1 in 5 birthing parents during the postpartum period. The American Academy of Pediatrics (AAP) recommends screening birthing parents for PPD at well-child visits within the first 6 months of the infant's life. The Edinburgh Postpartum Depression scale is a well validated tool used to identify postpartum depression in the birthing parent. Local Problem: A site assessment at an outpatient pediatric clinic identified practice differences among the pediatric providers once a EPDS screen was completed. The provider group expressed interest in standardizing their approach with results of EPDS screens. Methods: To increase screening and referral rates by standardizing care when screening birthing parents for PPD with the utilization of a screening protocol tool. Interventions: A screening protocol was adapted and created with targeted interventions depending on the EPDS score and symptoms expressed by the birthing parent. The protocol utilized for this project was adapted by a stepwise approach protocol created by Olin et al., (2017) called "PPD Stepped Care". Additionally, an educational pamphlet with associated resources was created to aid the providers in creating dialogue about PPD during well-child visits. Results: Surveys revealed most staff and providers within the clinic found screening for PPD to be important for pediatric health and well-being. Screening rates and referral practices improved from baseline data after the implementation of the standardized screening tool. The provider group determined continued use of the standardized screening protocol tool in practice beyond the implementation period for this DNP project. Conclusion: This project provided an outpatient pediatric clinic an improved screening process for PPD and standardized a referral process for birthing parents who have been determined positive using the EPDS tool.Item Postpartum depression: standardization of the referral and screening process(Montana State University - Bozeman, College of Nursing, 2024) Liedtka-Holmquist, Diana; Chairperson, Graduate Committee: Lindsay Benes; This is a manuscript style paper that includes co-authored chapters.Approximately 6.5% to 20% of women will experience postpartum depression (PPD), which can have lasting negative effects on both mother and newborn. Universal screening of women for PPD is recommended; however, less than 20% of women undergo guidelines- consistent screening during pregnancy or postpartum. Early identification of PPD through consistent screening, follow-up, and referral can improve maternal outcomes. This project aimed to standardize each part of the process to improve PPD outcomes in a women's health and newborns unit in Western Montana providing comprehensive obstetrics/gynecology, maternal- fetal medicine focusing on high-risk pregnancy and births. The standardized process required RNs to screen all patients with the EPDS (Edinburgh Postnatal Depression Scale), with scores 13 or greater generating an automatic referral to social work. After receiving the referral, social workers follow up with the patient, addressing concerns, providing education to the patient, and referring to additional resources. Following the implementation of the standardized process, the unit saw an increase in EPDS screening rates from 78% to 92%. Seventy-one percent of patients (5 out of 7) who screened positive on the EPDS received a follow-up by the social worker. Postpartum awareness and education materials identifying signs and symptoms of PPD were provided for all patients and families. Having a plan in place for a positive EPDS screen facilitates effective referral and follow-up treatment for women suffering from postpartum depression allowing for the appropriate intervention.Item Screening for perinatal mood and anxiety disorders during well-child appointments: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2023) Buscher, Jennifer; Chairperson, Graduate Committee: Christina BorstPerinatal mood and anxiety disorders (PMADs) are prevalent among birthing individuals. Conversely, PMAD screening rates are insufficient to support assessment, making PMADs the most underdiagnosed obstetrical complication in the United States. This quality improvement project aimed to improve PMAD screening and referral rates within one pediatric clinic. Prior to implementation, the pediatric clinic was screening with the PHQ-2 at 2-month well child checks. The purpose of this initiative was to update the clinic's screening process to align with current clinical practice guidelines as outlined by the American Academy of Pediatrics. The Edinburgh Postnatal Depression Scale (EPDS) was provided to birthing individuals at each 2-week, 2- month, 4-month, and 6-month well-child check appointment. Individuals who screened positive were provided with follow-up support. Over six weeks 152 birthing individuals were present for 2-week, 2-mo, 4-mo, and 6-mo well-child check appointments. Among these women, 129 (85%) were screened with the EPDS. Among those individuals, 14 (11%) had a positive score. Among the positive scores, 8 (57%) were addressed for follow-up recommendations. When following clinical practice guidelines, more birthing individuals were screened for PMADs and referred for follow-up support as compared to the previous screening intervention used by the pediatric clinic which was misaligned with clinical practice guidelines. This quality improvement project effectively increased PMAD screening rates and amplified awareness of the topic. Additional PDSA cycles are recommended to bolster adequate follow-up among individuals scoring positive.Item Improving sleep opportunities in hospitalized postpartum mothers(Montana State University - Bozeman, College of Nursing, 2022) Cantwell, Lindsay Rose; Chairperson, Graduate Committee: Christina BorstSleep deprivation and the fatigue experienced by new mothers remain well-accepted facts of life after the birth of a newborn. In the past, most new mothers utilized hospital nurseries to aid them in caring for their infants after birth; but recent paradigm practice changes in hospitals emphasize rooming-in, breastfeeding, and strongly discourage separation of the mother/newborn couplet. In Baby-Friendly accredited hospitals, postpartum mothers are encouraged to prioritize their infant's needs often above their own, contributing to significant maternal sleep deprivation and fatigue. This quality-improvement project aimed to increase sleep/rest opportunities for mothers through the implementation of coordinated quiet times on a postpartum unit in a Baby-Friendly hospital in the northwestern area of the United States. The Knowledge to Action framework guided this project. Staff received education about the importance of postpartum sleep and the quiet-time practice change. The implementation took place over 4 weeks. Chart reviews were completed, and the mothers who received quiet times were tracked. Practice outcomes included 51% of postpartum moms having a quiet time during week 1; week 2, 64%; week 3, 57%; and week 4, 62%. The quality-improvement project successfully increased sleep/rest opportunities for mothers through quiet times. Prior to the project, there was no standardized effort on the unit to promote maternal sleep or rest. An increase of over 50% during all practice weeks was accomplished. Additionally, there was no significant increase in infants utilizing the nursery, making this intervention viable in the Baby-Friendly hospital setting.