The Business Case for Quality: Implementation of a Patient Health Questionnaire-9(PHQ-9) Screening Tool in Patients with Major Depressive Disorder (MDD): A Quality Improvement Project to improve patient outcomes in an Inpatient Mental Health Setting at a Baptist health hospital in San Antonio
NOTE:
- Please review this about PHQ-9 Screening /logic model
General Information
In 2020, an estimated 14.8 million U.S. adults aged 18 or older had at least one major depressive episode with severe impairment in the past year. This number represented 6.0% of all U.S. adults (Major Depression, 2020). For MDD, the estimated total cost of care is about $9,506 higher (50 percent higher) than the cost for patients in usual care at Baptist Medical Center in San Antonio at an adult psychiatric mental unit. Therefore, utilizing depression screening is crucial in preventing poor outcomes. Providing early evidence-based interventions with support systems can be achieved with consistent screening by nurses while providing depression education on a daily basis. The lack of use and adherence to screening tools such as PHQ-9 that aid in the identification of mental health disorders can lead to an increase in inpatient hospital stays and readmission rates.
Problem Statement
The prevalence of a depression tool such as PHQ-9 is widely unacknowledged and it is a specific problem at the BMC inpatient psychiatry unit. Poor or lack of screening can alter patient outcomes. Also, the injury that individuals sustain from being severely depressed as an adult may continue to adversely affect their health in various ways, including having risky negative behaviors such as having thoughts of suicidal ideation/tendencies or practicing illicit drug relapse. In inpatient hospitals, patients can be diagnosed with depression and have additional symptoms of brief psychosis episodes, change in appetite/energy, suicidal ideation, and mood swings, or can sometimes also be triggered by stressors such as family turmoil and financial instability. A 2016 systematic review and meta-analysis found that depression symptoms are associated with higher rates of readmissions and mortality (Pederson et al., 2016).The main focus is to initiate the PHQ-9 screening for MDD patients admitted to mental health. In addition; the PHQ-9 scores will serve as a guide to improve patient incomes such as creating individualized treatment plans; which can include better and affordable resources (housing, food, etc), increase medication adherence compliance, and decrease readmission rates. Utilizing the PHQ-9 screening tool is crucial for patient outcomes and can be achieved with consistent screening by nurses while providing ongoing depression education on a daily basis.
Population
In this quality improvement project; PHQ-9 screening tools will be used on adult male and female patients 55 years and older with an admission diagnosis of MDD.To create less confusion, this project will choose one tool (PHQ-9) and one topic to focus on (improving patient outcomes). The project site only admits adults 55 years and older with a mental disorder. In this project, Only the PHQ-9 screening tool will be used to screen depression in adults with a diagnosis of Major Depressive Disorder. Inclusion criteria: Inpatient hospital, Psychiatric hospital, Healthcare Providers, Adult, Readmission rate, PHQ-9, Depression, and medical diagnosis of MDD.
Procedures
The PHQ-9 screening form (including a similar copy in this document) will be provided to nurses to collect results within 4 hours of admission into the mental health setting. No provider order is needed to complete the screening. However, inpatient hospitals need to increase nurses’ awareness to complete routine PHQ-9 screening preferably with patients after the nursing initial assessment at admission. All learners including nursing staff and social workers will be mandated to attend a 15-20 minutes PowerPoint presentation before implementing the PHQ-9 screening. The multidisciplinary team (RN, NPs, SWs, RTs, MHT, and MDs) will be invited to complete anonymous surveys via Qualtrics. The surveys are composed of questions focused on the learner’s perceived confidence as related to the PHQ-9 management and influence on patient care.
Risks and Benefits
Risks: Staff distress and poor performance to complete the screening tool in a timely manner and lack of staffing or resources (Lack of education about 988 Suicide & Crisis Lifeline; providing or scheduling patients for a free UTSA Sarabia Family Counseling Center; Locating local housing shelter or food pantries etc.) can create negative outcomes. Benefits: PHQ-9 screening can be completed without a provider order and be administered by any healthcare provider including nurses. In addition; the PHQ-9 screening tool can be used to easily obtain focus nursing assessment in order to direct or monitor patient care. PHQ-9 screening tools can be cost- effective and easy to understand and aids in improving outcomes.
References
Kroenke, K., & Spitzer, R. L. (2002, August 31). The phq-9: A new depression diagnostic and severity measure. Scinapse.
Major depression. (2020, January 31). National Institute of Mental Health (NIMH).
Logic model
| Inputs | Constraints | Activities | Outputs | Short Term | Long Term | Impact |
| Personnel: Clinician: Nurses and medical providers such as psychiatrists, and psychiatric mental health nurse practitioners. Non-clinicians: Social workers, mental health nursing techs, and recreational therapists. | Budget: Low hospital census can affect staffing Lack of resources for recreational activities and affordable depression referrals. Lack of nursing staffing because of paid cuts. | Events: One-page handout information the PICO question or Optional PowerPoint presentation on the DNP project and Nurses will spend 5 to 10 minutes during shift reports discussing the DNP project and answering any questions. | # of participants: Only patients diagnosed with Major Depressive Disorder(MDD) will participate. | Knowledge improvement: Assess nursing knowledge pertaining to the DNP project on daily basic Assessing knowledge skills on what topic to discuss during treatment teams. | Behavior improvements: Be ready for change Create mindful teamwork and balance time Be positive | Long-term results of change: The implementation of the PHQ-9 will improve the readmission rate and promote good quality of care. |
| Financial: There is financial needs needed for the project | Physical Space: The inpatient unit is 22 acute beds for any patient diagnosed with a medical condition. | Training: Every healthcare personnel must be educated on the PICO question and understands the intervention and outcome goal. | Amount of Education delivered: Depression education will be delivered on daily basic during treatment team and discharge. | Improve competencies: 1. Use time management wisely. 2. Gain more knowledge on to conduct a PHQ-9 screening accurately. | ||
| Time: 1.Day and night shift | Law, regulation and local policy: Promote safe care Follow unit rules Comply with hospital/university policy. Focus on patient needs and follow Providers orders. | Education: 1. Every healthcare personnel must have valid credentials. | # of hrs. of service: 1.Nursing school will determine the hours. | |||
| Materials: 1.PHQ-9 screening tool paperwork 2. Pen and pencil 3. Printer 4. Computer etc | Timeframe: 3 to 6 months | Media/Technology: Good working network connection and computer. | ||||
| Equipment: computer | Existing culture: 1.Some patient can be fluent in speaking Spanish only. | Meeting: Nurses will be mandated to attend treatment teams three times a week. | ||||
| Facilities: 1.Baptist Medical Hospital in San Antonio, Texas. | Development of process: Per JCAHO and hospital policy; the development process will be ready around the implementation stage of the DNP project. | |||||
Logic Model
MDD: Major Depressive Disorder
PHQ-9: Patient Health Questionnaire
DNP:Doctor of Nursing Practice
JCAHO: Joint Commission on Accreditation of Healthcare Organizations
Assumptions:
- Lack of psych nurse staffing or resources from social workers.
- Type of insurance or no insurance can may determine depression resources.
- Patient lack of participation can affect the outcome
- Patients lack untrustworthy in answering the PHQ-9 screening tool
- Lack of nurses not implementing with the DNP project.
External Factors:
1. Poor hospital location
2. Increase homeless population
- Please use this facility for the assignment: Baptist medical hospital in San Antonio
- References must be within 5 years
- Please used/follow the rubric
- The paper is limited to no more than 10 pages, not including the title page, references, and appendix.
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