Perinatal Mood Disorders: Implementation of a Hospital Based Screening Program

Purpose for the program: How can the mother-baby nurse initiate a "realistic" screening process to identify women At Risk for Perinatal Mood Disorders and what support services can we offer?

Proposed change:

Develop a realistic screening and referral process which empowers the mother-baby nurse to assess and refer a mother who has the potential of developing a perinatal mood disorder to Home Care for continued assessment and evaluation after discharge.

Implementation, outcomes and evaluation:

The Perinatal Mood Disorder project was borne from an identified gap in services or follow-up in the community for women at risk for perinatal mood disorders. The nursing staff collaborated with senior leadership, administration and the Home Care Department to determine the feasibility of developing a nurse driven Home Care referral process. Upon arrival to the mother-baby unit, the nursing admission assessment includes a simple screening tool utilizing three questions. A positive response to one question regarding personal or family history of psychiatric illness triggers a referral to social work, flagging the chart for the obstetrician and pediatrician, and a direct home care referral. The Home Care Intake nurse meets with the mother prior to discharge. The patient makes the decision regarding participation in the follow-up program. A telephonic screen is conducted by the Home Care Social Worker 4 - 5 weeks later. A home visit occurs 24 - 48 hours later based upon patient assessment and obtaining a physician order. A physical and psychosocial assessment is performed, education and emotional support provided and community services and referrals are arranged. Since the initiation of the program in March of 2008 more than 1581 nurse driven referrals were generated, 1014 telephone assessments and 182 home visits made and psychiatric intervention increased by 33%. The Perinatal Mood Disorder program has been well received by the mothers, families, the medical community and has proven to be effective, and realistic identifying women at risk and providing follow-up care.

Implications for nursing practice: The screening of all patients upon admission to mother-baby and subsequent referrals has become standard of care and the development of Patient Specific Standards: Pregnancy Related Affective Disorders. Nursing leadership is at the core of this program as demonstrated by the staffs' ability to initiate effective change management related to an issue the bedside nurse identified. The staff demonstrated professionalism with their commitment to evidence-based clinical and managment practice. Nursing's leadership in this often undiagnosed disorder has provided awareness to the entire healthcare team and certainly has influenced how patients are managed.

Keywords: Perinatal Mood Disorders, Hospital Screening, Home Care