Using a Consensus Bundle to Improve Maternal Perinatal Mental Health

Jennifer Garcia

February 10, 2017

A new consensus bundle aims to help healthcare providers implement evidence-based guidelines for the diagnosis and management of perinatal maternal mental health conditions.

"The bundle seeks to provide a framework to assist providers, regardless of clinical setting, in developing a consistent approach to screening for perinatal mood and anxiety disorders and developing brief interventions as well as strategies for referral, response to emergent situations, and follow-up to ensure continuity of care," said lead author Susan Kendig, JD, MSN, from the National Association of Nurse Practitioners in Women's Health, Washington, DC.

These implementation recommendations, published in the March issue of Obstetrics & Gynecology, are based on guidelines developed in 2015 by the Council on Patient Safety in Women's Health Care.

The authors note that perinatal depression can occur during pregnancy or within 4 weeks after birth and can lead to adverse outcomes for both the mother and the child.

In an effort to improve perinatal outcomes and improve maternal mental health, the commentary outlines ways for providers to identify, treat, and prevent depression and anxiety in this population. The recommendations are divided into four main areas — readiness, recognition, response, and reporting — and can be applied in various healthcare settings.

For example, the authors discuss the various mental health screening tools available for use in pregnant and postpartum women and make recommendations for tools that have been validated and are easy to use in daily practice.

Further, Kendig and colleagues recommend that consideration be given as to when these screenings are administered, as depressive events may occur at any time during the perinatal period, and they encourage practitioners to have a response protocol in place to facilitate immediate intervention if maternal or infant safety are in jeopardy.

Recommendations around preparing a response protocol include identifying available mental health providers in the area to which the patient can be referred, as well as the availability of other resources, including local support groups and familial support.

In an effort to improve adoption of these measures overall, the authors recommend identifying a staff member who will be responsible for helping ensure that screening tools and response protocols are consistently used.

Health providers are often the first line of defense in recognizing the signs of perinatal depression, and "the shortage of mental health professionals in many areas poses one of the greatest challenges as providers seek to implement approaches to addressing maternal mental health problems," Kendig said in an interview with Medscape Medical News.

"By working through the bundle framework, providers can think through response and referral mechanisms and how to leverage resources and supports available to their patients before the need arises, rather than in the moment when the patient presents." 

The study authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2017;129:422-430. Abstract

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