A summary of the application of the quality improvement methods to improving access to post partum depression screening by public health nurses in the Comox Valley

1. Improving the Access to the Edinburgh
Post Partum Depression Screen in the
Comox Valley when Administered by
Public Health Nurses in 2016-17
March 9, 2017

2. Anecdote
I am feeling blue these
days…
I wish someone would
ask me how I am
feeling.

3. Background
• Post partum depression is an important and prevalent
health issue
• The Edinburgh Post-Partum Depression Screen (EPDS)
is intended to be offered to all women in the last
trimester of pregnancy, at post-partum between 6 and 8
weeks, and again at 6 months.
• The EPDS completion rate in the Comox Valley is
relatively low, around 42%, at 10 weeks post-partum
• The EPDS is offered to about 67% (completed or
declined) of women on the phone or in person.
• Staff identified improving EPDS offering at a local QI
workshop as a priority

4. Percent of Women Contacted or not able to be Contacted by Telephone between 5 and 10 weeks Post-Partum

5. Percent of Woman Offered or Not Offered EPDS during either type of contact with Public
Health Nurse

6. Percent of Women who completed the EPDS on the Telephone or at CHC in Comox Valley between Sept and Nov 2016
*Not completed includes women who declined to participate in EPDS

7. Aim of the Project
Increase the offering of EPDS (declined or
completed) from 67% of women to 100% of
women contacted by Public Health in the
Comox Valley by 10 weeks post-partum by
October 31, 2016 March 31, 2017.
Unrealistic schedule!!!
Needs to be revised!

8. Team Members
• Jenny Nijhoff
• Amber Thomas
• Joy Simms
• Terri Lidstone
• Brett Hodson

9. Actual and Percent of offering of EPDS Post-Partum to
Women in the Comox Valley between Sept and Nov 2016
%
Areas of potential
for improvement

10. Changes Tested
• Present baseline results and plans to CV Team
– MPH Report
– Local data collection
• PDSA 1: Add EPDS w/ scoring for self
assessment to baby package to improve offering
at 6 week call
• PDSA 2: Add EPDS during registration/check in
wait time at CHC appointment universally

11. Changes Tested
• PDSA 3: Engage women to inform project
Explore phone offering v. at CHC
Helpful having EPDS available for self
assessment/guiding conversation with nurse
• PDSA 4: Improve instructions for collecting
EPDS offering data

12. % of Women Offered of EPDS by any means
within PH from Feb 1 to Mar 1 2017
Date of CHC
%ofWomenOfferedEPDS
Median rate of EPDS offering over
3 month period prior to test
interventions

13. Lessons Learned
• Set realistic goals with respect to time.
• The results of nursing documentation review completed
by the nurse in the Comox Valley is consistent with the
review conducted by the MPH student.
• Most women are contacted at 6 or 7 weeks post-partum
via telephone
• Most women who did not complete the EPDS at the 6
week phone visit do not get the opportunity at the 2
month CHC visit
– EPDS is often declined or deferred during the telephone surveillance
call, and not re-offered at the CHC visit. (Re-offering of EPDS is not
routine if the woman initially declined it during the 6 week phone visit)
– EPDS is often not offered at CHC visit if the woman was not contacted
via telephone.

14. • Nursing documentation of the EPDS
outcomes is of very good quality.
• Using a ‘Pareto Chart’ can help identify
priority areas for improvement/change
• Instructions to nurses on how to use data
collection tools needed to be better
• QI work requires time, commitment, and
discipline!
More Lessons Learned…

15. Contact Information
Jenny Nijhoff, Nurse Coordinator
Comox Valley Community Health Centre
250-331-8566
jenny.nijhoff@viha.ca
Brett Hodson, Manager
Comox Valley/Campbell River
250-331-8558
brett.hodson@viha.ca
@hodson4qph