Date of Degree
Doctor of Nursing Practice (DNP)
Jean Dowling Dols
Purpose: This project was designed to strengthen the quality of depression assessment with evidence-based depression assessment tools in inpatient psychiatric units.
Background: Missed diagnosis and treatment of depressive disorders contribute to the most severe outcome of depression: suicide. A crisis stabilization facility with inpatient psychiatric units had significant opportunities to improve clinical outcomes by screening for depression in adults and to monitor symptoms with evidence-based tools.
Methods: The 12-week quality improvement project included implementation of staff education sessions of evidence-based tools to screen, monitor, interpret scores, and detect risk modifiers. The design and build with Information Technology for Personal Health Questionnaire 2 (PHQ-2) daily scores in the electronic health records, adding admission score of depression assessment tool on nursing handoff reports, improved nurse-provider communication, design of PHQ-2 algorithm, design of flowchart impacting nursing workflow, and revision of the patient goals sheet replacing a numeric scale with the PHQ-2 for depression assessment daily and per shift as needed.
Results: Achieved 100% participation in staff educational sessions, established new standard in nursing with Personal Health Questionnaire 9 (PHQ-9) built into shift report sheets, patient completion of daily goals sheets with PHQ-2 increased from 0% to 52.3%, identification of risk factors in patients with Major Depressive Disorder (MDD) including 61.5% history of abuse in lifetime and 62.5% history of Post-Traumatic Stress Disorder (PTSD). Increased provider adherence to evidence-based clinical guidelines in the management and treatment of MDD with 61.7% of patients referred to psychotherapy, 56.8% of patients were prescribed clinical guideline’s 1st line of treatment antidepressants selective serotonin reuptake inhibitors, and 56.4% of patients were prescribed with augmentation pharmacotherapy second generation antipsychotics. Descriptive statistics resulted in referrals to outpatient psychotherapy in 53.2% of funded patients and 46.8% of unfunded patients.
Conclusions: Expanding knowledge and use of evidence-based depression assessment tools in an inpatient setting assisted with management, treatment, and post-hospitalization referrals. Guiding the project with DNP Essential II: Organizational and Systems Leadership for Quality Improvement and Systems Thinking involved continuous tracking and modifying the project with feedback from different components (e.g., licensed clinical social workers (LCSWs), pharmacists, providers, nursing staff, technicians, administration) using evidence-based clinical guidelines.
Flores, Lucy, "Implementing Evidence-Based Adult Psychiatric Inpatient Depression Assessment, Treatment, and Post-Hospitalization Referral" (2022). Doctor of Nursing Practice. 108.