Tuesday, February 23 1:00 p.m. Eastern

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1 Tuesday, February 23 1:00 p.m. Eastern Dial In: Conference ID: Slide 1

2 Speakers John Keats, MD, CPE, FACOG Market Medical Executive, Cigna Health Care of Arizona Susan Kendig, JD, WHNP-BC, FAANP Director of Policy, National Association of Nurse Practitioners in Women's Health; Teaching Professor and WHNP Emphasis Area Coordinator, University of Missouri St. Louis Slide 2

3 Disclosures John Keats, MD, CPE, FACOG is a national senior medical director for Cigna Health Care. Susan Kendig, JD, WHNP-BC, FAANP has no real or perceived conflicts of interest. Slide 3

4 Objectives Provide an in-depth overview of the Maternal Mental Health: Perinatal Depression and Anxiety Patient Safety Bundle. Take a look at the processes, methods, and tools that were used to develop the bundle. Give suggestions for how to effectively implement and utilize the bundle within your organization. Identify resources to customize the bundle for use within your organization. Slide 4

5 Scope of the Problem CDC estimates 8-19% of women will experience a depressive episode during or after pregnancy Untreated maternal depression can have a devastating effect on women, their infants and their families In extreme form, depressive psychosis can lead to maternal suicide and/or infanticide Maternal suicide within a year of birth exceeds hemorrhage and hypertensive disorders as a cause of maternal mortality, and is probably underreported. Slide 5

6 Current Position Statements American Academy of Pediatrics published a guideline in 2010 Advocated for pediatricians to screen mothers for depressive symptoms at well child visits at 1, 2 and 4 months of age. Recognized that maternal depression can cause failure-to-thrive and other pediatric issues if unrecognized ACOG published Committee Opinion #630 in May 2015 Recommended that obstetricians screen patients at least once during the perinatal period for depression and anxiety symptoms using a standardized, validated tool. Listed various acceptable screening tools US Preventive Services Task Force Recommendation Statement Jan Recommends depression screening for pregnant women for the first time. Screening should be done both antepartum and postpartum. Now Council on Patient Safety in Women s Health Care is adding its recommendations Slide 6 Earls, Marian F., et al. (2010). Clinical Report Incorporating Recognition and Management of Perinatal and Postpartum Depression Into Pediatric Practice. Pediatrics, 126(5), DOI: Screening for perinatal depression. Committee Opinion No American College of Obstetricians and Gynecologists. Obstet Gynecol 2015; 125: Depression in Adults: Screening. U.S. Preventive Services Task Force. JAMA. 2016; 315 (4):

7 Maternal Mental Health: Perinatal Depression and Anxiety Patient Safety Bundle Development Multidisciplinary Team Readiness Emily Miller Lead Sue Kendig Katherine Wisner Recognition Tiffany Moore-Simas Lead Ariela Frieder Chris Raines Response Camille Hoffman Lead Barbara Hackley Pec Indman Reporting & Systems Learning Lisa Kay Lead John Keats Kisha Semenuk Slide 7

8 4 Domains of Patient Safety Bundles Readiness Recognition & Prevention Response Reporting/Systems Learning Slide 8

9 Slide 9

10 Readiness: Every Clinical Care Setting Identify mental health screening tools to be made available in every clinical setting (outpatient OB clinics and inpatient facilities). Slide 10

11 Readiness: Every Clinical Care Setting Establish a response protocol and identify screening tools for use based on local resources. Slide 11

12 Readiness: Every Clinical Care Setting Educate clinicians and office staff on use of the identified screening tools and response protocol. Slide 12

13 Readiness: Every Clinical Care Setting Identify an individual who is responsible for driving adoption of the identified screening tools and response protocol. Slide 13

14 Slide 14

15 Recognition: Every Woman Obtain individual and family mental health history (including past and current medications) at intake, with review and update as needed. Slide 15

16 Recognition: Every Woman Conduct validated mental health screening during appropriately timed patient encounters, to include both during pregnancy and in the postpartum period. Slide 16

17 Recognition: Every Woman Provide appropriately timed perinatal depression and anxiety awareness education to women, family members, or other support persons. Slide 17

18 Slide 18

19 Response: Every Case Initiate a stage-based response protocol for a positive mental health screen. Slide 19

20 Response: Every Case Activate an emergency referral protocol for women with suicidal/homicidal ideation or psychosis. Slide 20

21 Response: Every Case Provide appropriate and timely support for women, as well as family members and staff, as needed. Slide 21 Access the Patient, Family, and Staff Support after a Severe Maternal Event Patient Safety Bundle here

22 Response: Every Case Obtain follow-up from mental health providers on women referred for treatment. This should include the necessary release of information forms. Slide 22

23 Slide 23

24 Reporting/Systems Learning: Every Clinical Care Setting Establish a non-judgmental culture of safety through multidisciplinary mental health rounds. Slide 24

25 Reporting/Systems Learning: Every Clinical Care Setting Perform a multidisciplinary review of adverse mental health outcomes. Slide 25

26 Reporting/Systems Learning: Every Clinical Care Setting Establish local standards for recognition and response in order to measure compliance, understand individual performance, and track outcomes. Slide 26

27 Conclusion Maternal depression and anxiety are significant medical issues for our patients, and to date have often gone unrecognized Severe forms of depression can be a cause of maternal mortality Recommendations for perinatal depression and anxiety screening have proliferated This bundle is intended to provide recommendations for establishing screening for depression and anxiety in all obstetrical practice settings A commentary to accompany this bundle will be forthcoming in the next few months Slide 27

28 Q&A Session Press *1 to ask a question You will enter the question queue Your line will be unmuted by the operator for your turn A recording of this presentation will be made available on our website: Slide 28

Eastern Rita Brennan, DNP, RNC-NIC, APN/CNS Outcomes Manager, Women & Children s Services, Northwestern

29 Future Safety Action Series Supporting Intended Vaginal Births through Patient Education and Shared Decision Making Thursday, March 24, :00 p.m. Eastern Rita Brennan, DNP, RNC-NIC, APN/CNS Outcomes Manager, Women & Children s Services, Northwestern Medicine, Central DuPage Hospital Brownsyne Tucker Edmonds, MD, MPH Assistant Professor, Obstetrics and Gynecology, Indiana University School of Medicine Click Here to Register Slide 29

Monday, August 15, :00 p.m. Eastern

Monday, August 15, :00 p.m. Eastern Monday, August 15, 2016 2:00 p.m. Eastern Dial In: 888.863.0985 Conference ID: 34874161 Slide 1 Speakers Deb Kilday, MSN, RN Senior Performance Partner Performance Services Quality & Safety Premier, Inc.