Purpose for the program:  There are missed opportunities to screen women for postpartum depression (PPD) and refer them for appropriate follow-up care.  Called “Know Before They Go©,” this pilot program evaluated the feasibility of establishing a standardized screening and referral process in the immediate postpartum period.  A description of how it was implemented and the cost-benefit analysis will be reviewed.  Nurse managers can use this information to develop a similar interprofessional program at their institution to improve patient safety and optimize the level of service they provide postpartum women.        

Proposed change: Implement early screening and referral for PPD 

Implementation, outcomes and evaluation: Forty-eight patients were consented during their pregnancy to be screened for depression at 12 to 36 hours after giving birth. Two prelicensure nursing students, who served as research assistants, measured the length of time to distribute, collect, and score the screens. The nurses reviewed and discussed results with the patients and documented the findings into the medical record.  Per the early screening protocol developed for this pilot, those women who screened positive (> 12 on the Edinburgh Postnatal Depressive Scale) for severe depression were offered social work and behavioral health consults.  When patients in the pilot returned for their 6-week postpartum visit, they were given a survey about their participation in the program.  From a process standpoint, the pilot ran smoothly. Consistent with the literature, 6.25% of women screened positive for major depression. Patients willingly completed the screen in a timely manner, the response of the various disciplines was prompt, there were no delayed discharges as a result of a positive screen, and there was support from patients, nurses, and physicians.  The cost per patient with a negative screen was $3.23 and $4.98 for a positive screen based on a nurse's salary of $35.00 per hour. As part of the pilot, nurses and physicians were invited to educational sessions on PPD. Outcomes show that screening in the immediate postpartum period is feasible and relatively inexpensive for the Department of Nursing.  One of the three women with a positive screen sought follow-up mental health treatment while another cited transportation issues as a barrier to treatment. 

Implications for nursing practice:   AWHONN believes that nurses are in a key position to assess new mothers for symptoms of depression and provide education/appropriate referral information for the treatment of PPD. Improved marketing, identification of barriers to treatment, and universal implementation are recommendations to improve access to mental health follow-up for this vulnerable population. 

 Keywords: postpartum depression, early screening, postpartum depression treatment, Illinois PA 095-0469