Date of Graduation

Summer 8-12-2021

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

First Advisor

Liesel Buchner

Second Advisor

Sara Horton-Deutch

Third Advisor

Cathy Coleman

Abstract

Problem: The potential harm to women and infants due to untreated perinatal anxiety and mood disorders is both a patient safety and a public health concern. Studies show that mental health decline during the postpartum period is associated with increased morbidity and mortality for both the mother and infant. The project aim was to utilize the initial screening of perinatal patients using the Columbia-Suicide Severity Rating Scale (C-SSRS) as the baseline screening tool. The tool will help implement a standardized workflow for patients who screen low, moderate, or high, as this workflow had yet to be developed.

Context: In July 2019, the Joint Commission released new elements to their National Patient Safety Goal 15.01.01: Reduce the risk for suicide, which required suicide screening for all admitted patients. In August 2020, the hospital in this study screened all patients with the C-SSRS on admission. Even when hospitals screen patients for suicide or other mental health disturbances, a nationally accepted standard workflow for positive screens does not exist. This improvement project focused on creating a standardized workflow for perinatal patients who screened positive on the C-SSRS by implementing an inpatient clinical pathway.

Interventions: The primary intervention for this project was to create the inpatient clinical pathway for perinatal patients who screen positive on the C-SSRS. The initial step in the pathway was to ensure all positive patients had a social work consult, and those who scored moderate or severe also had an inpatient psychiatry referral. The secondary intervention was to ensure all patients received the Mind-Body-Spirit flyer containing outpatient resources for continued support when they are home.

Measures: To measure the success of the C-SSRS pathway, the team tracked all perinatal patients who screened positive on the C-SSRS. The outcome measure tracked the percentage of patients who screened positive on the C-SSRS and had the interventions completed. The first process measure followed all positive C-SSRS patients against the number of social work consults placed and seen before discharge. The second measure tracked all patients who screened moderate or high, the psychiatry consult was initiated, and the patient was seen before discharge. The third process measure was the percent of postpartum nurses trained to use the C-SSRS clinical pathway. The incidence rate of inappropriate referrals to social work and psychiatry was used as the balancing measure.

Results: Of the perinatal patients who screened positive (low, moderate, high) on the C-SSRS, 100% had a social work referral and were seen before discharge. Of the patients who screened moderate or high, 100% had an inpatient psychiatry referral and were seen before discharge. The safety plan was not initiated on the one patient who screened high, as she was in active labor and the psychiatrist determined she was not actively suicidal. Education on the C-SSRS pathway was successful, with 95% of postpartum nurses receiving the instruction.

Conclusions: This project aimed to develop an inpatient clinical pathway to be used with 90% of perinatal patients who screened positive (low, moderate, high risk) on the C-SSRS. The hospital in this study was able to implement the C-SSRS pathway on the postpartum unit successfully.

Keywords: Columbia-Suicide Severity Rating Scale (C-SSRS), perinatal mental health, postpartum, screening tools

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