Diana Fryer BSN, RN-BC, BS Psychology Christena Raines, RN MSN APRN-BC UNC Center for Women s Mood Disorders: Perinatal Psychiatry Inpatient Unit Discuss the needs of this unique population that require a specialized free-standing, inpatient perinatal psychiatric unit. Define the integrative nursing orientation process. Describe the unit s therapeutic environment including programming, interdisciplinary support and physical structure. Fryer, Raines 1
Fall 2006 Universal screening Fall 2007 Dual NP hired for OB/GYN; Psych Winter 2009 Perinatal In-patient Pilot Program Spring 2004 Perinatal Clinic established Fall 2006 Established Resident Perinatal Clinic Fall 2009 Satellite Office Rex Hospital September 2011 Free Standing Perinatal In-patient Unit UNC Perinatal Mood Disorders Clinic was established in 2004 by 2 psychiatrists with an interest in Perinatal Psychiatry Established alliances within OB/GYN to facilitate the referrals Worked on increasing awareness by providing psychoeducation: Psychiatric and OB providers Psychiatric and OB Nursing staff OB patients and families General public Highlighted the need for a systematic and universal procedure for screening and treatment After implementing universal screening, our perinatal outpatient services increased and we began to identify more women needing inpatient hospitalization. We were unable to provide the specialized perinatal services for women requiring inpatient care on a general psychiatry unit including: Adequate time with baby Nursing staff and other staff trained in perinatal issues Specialized psychotherapy and psycho-education Obstetrical and lactation services Fryer, Raines 2
Our pilot program was a specialized unit embedded in our general geriatric psychiatric floor The pilot program was able to demonstrate that we could recruit the numbers of patients needed to make this a viable option It also gave us the opportunity to understand the need for dual trained nurses and a psychoeducation program to help fight the stigma associated with mental illness Facilitators Department of Psychiatry Administration Success of UNC s Perinatal Psychiatry Program we had documented patient flow and financial viability Support of the Department of OB/GYN Hospital Director of Nursing Director of In-house Psychiatric Nursing Perinatal Community Supporters Barriers Financial climate Changes in insurance coverage Stigma of mental health Lack of understanding of perinatal depression and the need for a specialized unit Fryer, Raines 3
This unique unit required development of an innovative nurse driven training program. Antepartum Education Labor & Delivery Education Post Partum Education NICU Observation Observe PMH-NP in Outpatient Clinic Attend a Post Partum Outpatient Support Group Monthly Unit Development Meetings Monthly Team Outings Monthly Supervision Fryer, Raines 4
Nutrition Lactation Yoga Domestic Violence Substance Abuse Diabetes Spirituality Post Partum Complications Electronic Fetal Monitoring Attend NP Led Orientation Our 5 bed in-patient unit provides tailored programming to meet the needs of our patients. Fryer, Raines 5
Individualized and group therapy Medication stabilization and management Psycho-education Skill Building Mind Body Focus Family Focus Introduction to the Unit Understanding Perinatal Mood Disorders Medications used in the treatment Types of Psychotherapeutic interventions Consultation by OB/GYN team Daily theme Journaling Discharge planning and after care Active participation in treatment plan with a multidisciplinary team Fryer, Raines 6
Biofeedback Behavioral Therapy Nutrition Exercise Sleep hygiene Time management Yoga Therapeutic yoga tailored to the unique needs of pregnancy and postpartum by certified instructor Meditation Spirituality Spiritual support from hospital chaplains with expertise in the perinatal period Mindfulness Art Music Mother/Infant Attachment Psychotherapy group Protected sleep hours Extended visiting hours Family night Lactation support Gliders in patient rooms Hospital grade breast pumps, refrigeration and freezer storage Certified Lactation Consultants Fryer, Raines 7
Partner Assisted Psychotherapy For women with a cooperative, committed partner Educates and trains the partner to be a co-therapist Initiated in our unit and extended into follow-up care Weekly meetings on our inpatient unit Partner packets Partner Self-Assessment tools Patient Satisfaction Scores 100 80 60 40 20 0 Patient Satisfaction Scores Patient s Satisfaction I feel good and better about myself. My depression is gone. When I came to the hospital, they made me feel like I m someone and I m not alone I learned a lot about my postpartum depression Staff was great. I like the small unit and the one-to-one interactions with the staff At first I really did not want to be here but.i would really like to thank my nurses for giving me great advice and when I needed someone to talk to they were there and willing to listen Nurses were all so caring and loving, they made sure you were satisfied with everything All of the activities were excellent and their diversity was fantastic I especially appreciate the individual attention and modification of activities that was offered The UNC Perinatal Psychiatry Inpatient Unit provides intensive psychiatric care in a safe and supportive setting and helps to reduce stigma by educating patients and families. Nursing orientation with cross training modules in OB and Psychiatric Units prepares nurses to meet the holistic needs of Perinatal patients and fights stigma with accurate and research based information. Success of program required many invested faculty and staff across the hospital system. Program evaluation measured by patient participation in hospital surveys satisfaction demonstrates excellent treatment response and service satisfaction. Fryer, Raines 8
For more information www.med.unc.edu/psych/wmd/ Follow us on: Twitter: www.twitter.com/uncwomensmood Facebook: www.facebook.com/uncperinatalpsychiatryprogram David Rubinow, MD Chairman of Psychiatry & Director of Women s Mood Disorder Program Samantha Meltzer-Brody, MD MPH Director of Perinatal Mood Disorder Program Elizabeth Bullard, MD Attending Inpatient Perinatal Psychiatry Unit Lynne Burns, BSN, RN Nurse Manager of Inpatient Perinatal Psychiatry Unit Mary Tonges, PhD RN FAAN CNO & SVP of Nursing at UNC Anna Brandon, PhD, ABPP Barbara Bybel, DHA, MSN, NEA-BC, PMHNP-BC References Andrade SE, McPhillips H, Loren D, Raebel MA, et al. Antidepressant medication use and risk of persistent pulmonary hypertension of the newborn. Pharmacoepidemiol Drug Saf. 2009 Mar;18(3):246-52 Chambers C, Hernandez-Diaz S, VanMarter L, Werler M. 2006. Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. N Engl J Med. 354(6):579-87. Cohen L, Altshuler L, Harlow B, Nonacs R. 2006. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 295(5):499-507 Delatte R, Meltzer-Brody S, Cao H, Menard K. 2009 Universal Screening for Postpartum Depression: An Inquiry into Provider Attitudes and Practice American Journal of Obstetrics & Gynecology, 200(5):e63-4. Einarson A, Choi J, Koren G 2009 Incidence of major malformations in infants following antidepressant exposure in pregnancy: results of a large prospective cohort study. Canadian Journal of Psych, 54(4):242-6. Fryer, Raines 9
References Gavin N, Gaynes B, Lohr K, Meltzer-Brody S. et al. 2005 Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol. 106:1071-83 McKenna K, Koren G, Tetelbaum M, Wilton L et al. 2005 Pregnancy outcome of women using atypical antipsychotic drugs: A prospective comparative study. J Clin Psychiatry: 66:444-449. Robinson GE,, Psychopharmacology in Pregancy and Postpartum; FOCUS The journal of Lifelong Learning in Psychiatry (2012) volx p1-12. Warburton W, Hertzman C, Oberlander TF: A register study of the impact of stopping third trimester selective serotonin reuptake inhibitor exposure on neonatal health. Acta Psychiatr Scand 2010; 121:471-479. Fryer, Raines 10