Table 3.
Qualitative Report of Barriers to Implement PMAD Screening.
| Problems with the selection of PRO measures |
|---|
| • Barrier is not having an identified screening tool that is evidenced based |
| • I desire to use the Edinburgh scale but Mayo is resistant |
| • Mayo wanting a universal tool and universal practice/implementation |
| Institutional barriers |
| • I desire to use the Edinburgh scale but my institution is resistant |
| • Mayo wanting a universal tool and universal practice/implementation |
| • System is unclear and I am not in clinic enough |
| • Social work being utilized only when dismissal planning is needed |
| • We have not successfully integrated routine prenatal screenings into our practice |
| Limited resources to support PRO measures implementation |
| • Limited resources to manage psychiatric |
| • Minimal resources with quick timeline to evaluate/treat in behavioral health |
| • Resources not available in timely manner |
| • Limited resources for follow up care |
| • Once behavioral health needs are identified given time constraints for the pregnant woman, it is difficult to motivate the woman to engage in behavioral health services that often are difficult to access(limited qualified providers) |
| • When I screen at increase frequency I am seen as demanding more of nursing staff since “all the other providers are not doing it” also we cannot even refer internal patients to psychiatrist right now |
| Patient-level barriers |
| • Patient does not always complete |
| • Some patients choose not to complete |
| • Sometimes patient does not want to complete |
| • Once behavioral health needs are identified given time constraints for the pregnant woman, it is difficult to motivate the woman to engage in behavioral health services that often are difficult to access(limited qualified providers) |
| • Language barriers |
| • Patients are sick from medication and radiation so the test is not valid |
| Provider/staff-level barriers |
| • Sometimes the CA forgets to give the screen test. No barriers otherwise to screening outside of human error |
| • Already done by admission nurse |
| • Nurses not trained to hand out screening at specified intervals |
| • Lack of education and therefore consistency in screening through support staff |
| • Desk staff don’t always provide the tools on check in |
| • No standardized rooming procedure |
| • Staff not always consistent in giving the screen |
| • When I screen at increase frequency I am seen as demanding more of nursing staff since “all the other providers are not doing it” also we cannot even refer internal patients to psychiatrist right now |
| • Competing priorities; everyone has their favorite, evidence-based screen or test that needs to be done in 15 minutes |
| • I prefer to assess and have a conversation |
| • Work in domestic violence, not always applicable |
| Lack of training |
| • Nurses not trained to hand out screening at specified intervals |
| • Lack of education and therefore consistency in screening through support staff |
| • Knowing meds safe for pregnancy and breast feeding |