Answer

Outcome measures instruments and metrics

Introduction

A needs assessment was conducted at Union Public Health OBS/GYN clinic earlier in the month of October, 2017 to identify areas that need improvement. The assessment revealed that only 10% of the postpartum women who visited for their first postpartum visit were screened for postpartum depression (PPD). This is despite the fact that screening for this condition is financially efficient and requires only a small time investment (Madeghe, et al., 2016). Absence of early and accurate screening of postpartum depression results in serious negative consequences (Bitew, et al., 2017).

METRIC

SMART objectives were developed as a starting point for a quality improvement project for this clinic. The aim of the quality improvement project was to increase the proportion of women visiting the clinic who get screened for PPD. The outcome measures that will be implemented for the project will be the practice measures for each objective. Practice measures will enable us to evaluate how the actions in line with the objectives are being implemented.

Objective 1: The physicians and nurses will undergo training on postpartum depression screening from 6^th to 10^th November, 2017

This objective is necessary for the quality improvement project because it will ensure that the medical personnel have the knowledge and skills required to address the gap in care. The outcome of this objective is that physicians and nurses have the knowledge about PPD screening and be able to administer the screening instrument.

To measure this outcome, physicians and nurses will be provided with the Edinburgh Postnatal Depression Scale and asked to study it, then use it to screen for PPD in postnatal women. The intention is that they will the knowledge about the tool, its intended use, and be able to administer it to the patients.

Objective 2: Routine screening for post-partum depression during the initial post-partum visit will be incorporated within the clinic’s standard protocol by management by 13^th November, 2017.

Before the clinic can begin screening all postnatal women for postpartum depression, the guideline has to be incorporated within the standard protocol for provision of care for the clinic. This objective will ensure that PPD screening is one of the operating procedures at this clinic.

The outcome of this measure is the availability of actual PPD screening instruments at the clinic, to be administered to women during their initial postnatal visit. To measure this, an observation checklist will be used. The checklist will have a question such as: Are PPD screening instruments available at the clinic on a given day? If the answer is yes, then the next questions will be: How many PPD screening instruments are available at the clinic on this day?

Objective 3: Routine screening for post-partum depression will begin on 15^th November, 2017 for all post-partum women during their initial post-partum clinic.

After the medical personnel has been trained and screening instruments are available at the clinic, this objective will ensure that early and accurate screening of postpartum women for depression is routinely carried out at this clinic.

The outcome for this objective will be an increase in the proportions of women who get screened for PPD during their first postpartum visit. The instrument to measure this outcome will be a Crossectional survey, to be completed by all women attending the clinic. The survey will be conducted periodically to measure changes in the proportion of women getting PPD screening. The intention is that this proportion will improve over time.

INSTRUMENT

The instrument to be used to measure the outcome for the first objective is the Edinburgh Postnatal depression Scale (see appendix). While this instrument is one of the most extensively used for measuring depression and anxiety (Shrestha, et. al., 2016), its validity and reliability has continued to receive considerable attention. It has been considered to be of high reliability and validity in many cases (Boyd, et. al., 2005; Shrestha, et. al., 2016). However, its application in diverse cultures, where it has been necessary to translate it to the local dialect, not all aspects have been culturally adopted (Boyd, et. al., 2005). In such cases the reliability and validity has been challenged.

The data will be collected by first having each trained medical staff study the instrument, then have them administer it to postnatal women. The instruments will then be collected, the data analyzed and checked for completeness and accuracy by the senior physician, by comparing it with the standards available. Any discrepancies will be addressed appropriately and the process repeated appropriately until the desired level of knowledge is achieved.