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Implementation of a Resource Toolkit for Paternal Postpartum Depression: An Evidenced-Based Improvement Initiative
No full textPaternal postpartum depression (paternal PPD) or paternal major depressive disorder with peripartum onset is an under-researched and under-identified disorder. Approximately 8-14% of fathers will present with new symptoms of depression in the peripartum period, which ranges from the first trimester to 12 months after the child\u27s birth. An inadequate quantity of resources is available for patients and providers to help recognize and manage the disorder. Utah has a higher prevalence of both major depressive disorder and maternal postpartum depression disorder compared to the national average. The Utah Department of Health and Human Services has identified symptoms of a previous mental illness, elevated ACE scores, and co-occurring chronic illnesses as factors among those in Utah diagnosed with depression. These symptoms are associated with risk factors for the likelihood of a diagnosis of maternal postpartum depression. A quality improvement initiative was developed to improve participants\u27 confidence and knowledge in identifying and diagnosing paternal postpartum depression. Participants included one psychiatric mental health nurse practitioner, one physician assistant, and four therapists. All six agreed to participate in the initiative. Participants completed a pre-intervention questionnaire to assess current knowledge, beliefs, screening practices, and confidence levels in recognizing, screening, and diagnosing paternal postpartum depression. Educational resources were developed and provided to participants, including an educational presentation and toolkit titled "Uplifting Fatherhood," with resources to help identify the disorder and online resources for referring and supporting patients. Post-presentation questionnaires were administered to participants to determine satisfaction with the education and willingness to use the toolkit. The participants in clinical practice implemented the toolkit for 12 weeks, and the distribution of the toolkit was monitored. Participants were provided a post-intervention questionnaire to determine changes in screening methods, number of toolkits distributed, changes in confidence, barriers and improvements to the initiative, and feasibility, usability, and satisfaction. Intervention: Participants received an evidenced-based toolkit and education on paternal postpartum depression and implemented the toolkit into practice for 12 weeks. During the intervention period, the PDSA cycles were implemented to facilitate concurrent improvement and uptake of the toolkit. The number of toolkits distributed was tallied by participants during and at the end of the intervention period. Post-intervention, all six (n= 100%) participants agreed they gained the knowledge and training to identify the disorder and can make an accurate paternal PPD diagnosis. There was a slight increase in patient screenings and the use of the Edinburgh Postnatal Depression Scale (EPDS). All six (n=100%) participants believed the toolkit was simple to integrate into their practice and agreed to continue implementing it in the future. Participants identified the need for a physical handout or a QR code to provide the toolkit to their patients. The development and implementation of the Uplifting Fatherhood toolkit and educational presentation improved participants\u27 collective confidence in identifying, screening, and diagnosing paternal postpartum depression. Improving the data collection method for the distribution will be crucial for improving the replication of this initiative. Other disciplines, such as family medicine, pediatrics, and obstetrics, may be areas where a paternal postpartum depression toolkit may be useful to implement
Postpartum Depression Screening at Well-Child Visits: A Quality Improvement Project
No full textScreening for postpartum depression has traditionally been completed at the six-week postpartum visit. Postpartum depression, however, can occur anytime within the first year after giving birth and, when untreated, can have devastating effects. For this reason, multiple organizations recommend screening for postpartum depression at well-child visits. Current evidence indicates that utilizing well-child visits as a postpartum screening and referral platform can improve outcomes. A rural, privately-owned family medicine clinic in Idaho lacks a specific process for screening and referring for postpartum depression at well-child visits. We implemented a quality improvement project in a rural Idaho family medicine clinic from November 1, 2024, through December 31, 2024. The project focused on screening women bringing their newborns in for well-child visits in the first year of life for postpartum depression. We conducted semi-structured interviews and inductive thematic analysis to determine preexisting screening practices. We established baseline screening and referral rates through a review of the electronic health record (EHR) for two months, from August 1, 2024, to September 30, 2024. Then, we assessed screening and referral rates after implementation, and interviewed providers to determine the new process\u27s usability, feasibility, and user satisfaction. Using the Johns Hopkins Evidence-Based Practice Model, Plan-Do-Study-Act (PDSA) cycles, current evidence, and provider input, we developed clinic-specific guidelines for postpartum depression screening and referral at well-child visits. The guidelines directed the front office staff to provide a modified Edinburgh Postnatal Depression Scale (EPDS) to qualified patients which would then be reviewed by the physician. Those who scored positive for postpartum depression were given options for referral and/or treatment. Before implementation, none (0%, 0/25) of the charts reviewed had documented any postpartum depression screening or referral. After implementation, 82.6% (19/23) of charts demonstrated that postpartum depression screening and referral occurred. Interview themes included perceived barriers before implementation and suggestions for improvements after implementation. All providers found the clinic-specific guidelines for postpartum depression screening and referral usable, feasible, and satisfactory. Despite recommendations for postpartum depression screening at well-child visits, the literature shows that rates remain low. Through this quality improvement project, we demonstrated that implementing a postpartum depression screening and referral process could increase screening and referral rates for postpartum depression in mothers in the first year after giving birth. The literature also indicates that an increase in postpartum depression screening may lead to improved outcomes for the mother, baby, and family. Our hope is that other clinics can use these methods and interventions to improve outcomes at their clinics
Stress Intervention for Healthcare Workers in a Youth Residential Treatment Center: An Evidence-Based Project
No full textBackground: Healthcare workers in residential treatment centers experience high stress, which contributes to burnout, staff turnover, and poor patient outcomes. Stress management interventions for healthcare workers have been shown to improve well-being, decrease turnover, and improve patient outcomes. Healthcare professionals working in this residential treatment center for at-risk youth encounter a challenging work environment marked by significant stress. This stress arises from several factors, including frequent interruptions in their work, interactions with emotionally dysregulated youth, difficulties in collaborating with parents, and frequent staff turnover rates. Staff have been required to manage their work-related stress independently and separate from their work hours. This quality improvement project was conducted in four phases: assessment, development, implementation, and evaluation. The assessment phase included conducting preintervention surveys to evaluate healthcare workers\u27 experiences with work-related stress and the Perceived Stress Scale. The development phase included identifying a stress intervention, the Stress First Aid Model, and adapting it for use with healthcare workers at a residential treatment center. The implementation phase included staff training, recruiting stress-intervention champions, and activating peer-to-peer support interventions to manage workday stress. The evaluation phase included post-intervention surveys to re-evaluate experiences of work-related stress and scores on the Perceived Stress Scale, as well as the feasibility, usability, and satisfaction of the interventions among healthcare workers. Interventions: Interventions to address workday stress were tailored to the specific needs of individual healthcare workers and implemented utilizing tools from the Stress First Aid Model. The effectiveness of the interventions was evaluated using the Stress Continuum. This model enabled staff to employ customized strategies, including mindfulness, humor, uninterrupted breaks, and supervisory support in high-stress situations. The Plan-Do-Study-Act (PDSA) cycle was employed to facilitate iterative enhancements of the interventions throughout the project implementation period. Results: Pre-implementation work stress levels (0-100 sliding scale) during the most recent shift ranged from 8 to 75 (M = 53.1 ± 20.7); work stress levels in the past month ranged from 5 to 80 (M = 59.4 ± 24.0); anticipated work stress in the upcoming week ranged from 6 to 70 (M = 44.0 ± 22.5). Post-implementation survey results revealed that work stress levels during the most recent shift ranged from 9 to 50 (M = 27.2 ± 16.8); work stress levels in the past month ranged from 50 to 61 (M = 54.4 ± 6.0); anticipated work stress in the upcoming week ranged from 25 to 72 (M = 49.4 ± 16.6). In the post-intervention Perceived Stress Scale, three respondents had low stress, and three had moderate stress. Healthcare workers were likely to continue using the stress continuum and interventions at work. They found using the stress continuum for peer check-ins easy. They noted improved communication and connection among coworkers. Implementing the Stress First Aid Model with healthcare workers in a residential treatment center provided a framework for stress management and benefited most healthcare workers. The reported stress management benefits include increased communication and connection among coworkers, improved healthcare worker well-being, and improved communication among staff. Continued stakeholder engagement is essential for the sustainability and successful implementation of this quality improvement project
Implementing the Eat, Sleep, Console (ESC) Method for Treatment of Neonatal Opioid Withdrawal Syndrome (NOWS)
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Addressing Social Determinants of Health (SDOH) in Pediatric Constipation: A Quality Improvement Project
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Bridging the Gap: Provider-Led Transition from Pediatric to Adult Care for Patients Insured by Medicaid: A Quality Improvement Initiative
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