Last month, the Alliance for Innovation on Maternal Health (AIM) launched a new Patient Safety Bundle addressing perinatal mental health conditions. The current revision addresses gaps in the safety bundle previously released in 2016. Patient Safety Bundles are a structured way of improving the processes of care and patient outcomes. They are clinical condition-specific and follow an evidence-based, 5R structure, that when performed collectively and reliably have been proven to improve patient outcomes. “The goal of PSBs is to improve the way care is provided to improve outcomes. A bundle includes actionable steps that can be adapted to a variety of facilities and resource levels.”
AIM is supported through a cooperative agreement to ACOG through the U.S. Department of Health and Human Services’ (HHS) Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau (MCHB)
AIM is supported through a cooperative agreement to the American College of Obstetricians and Gynecologists (ACOG) through the U.S. Department of Health and Human Services’ (HHS) Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau (MCHB).
Greater Clarity of Recommendations
ACOG first recommended screening for perinatal mental health conditions in 2015. While this was a ground-breaking step in supporting the mental health of mothers, the initial recommendations were preliminary. Including what we have learned since launching the original recommendation, the new Patient Safety Bundle for Perinatal Mental Health Conditions is more specific about its guidelines and includes more resources for those caring for pregnant and postpartum patients. More specifically the new PSB:
- Broadens the scope of perinatal mental health conditions to include more clinical information on anxiety disorders and post-traumatic stress disorder
- Highlights the importance of identifying women at increased risk for perinatal mental health conditions
- Includes information on validated screening tools for mood and anxiety disorders in pregnant and postpartum women
- Provides very specific information on screening for bipolar disorder prior to the initiation of pharmacotherapy
- Outlines how to connect patients to mental health-specific resources
In collaboration with Dr. Nancy Byatt and other experts in perinatal mental health, the PSB also includes a detailed guide outlining how to implement these guidelines.
At a time when the Canadian Task Force recommended rolling back universal and instrument-based screening, it is a relief to see that other professional organizations have not followed suit.
Patient Safety Bundle for Perinatal Mental Health Conditions by Ruta Nonacs, MD PhD
For every patient, the Patient Safety Bundle recommends the following:
Screen for perinatal mental health conditions consistently throughout the perinatal period, including but not limited to:
- Obtain individual and family mental health history at intake, with review and update as needed.
- Screen for depression and anxiety at the initial prenatal visit, later in pregnancy, and at postpartum visits, ideally including pediatric well-child visits.
- Screen for bipolar disorder before initiating pharmacotherapy for anxiety and depression.
Screen for structural and social drivers of health that may impact clinical recommendations or treatment plans and provide linkage to resources.