Doctor of Nursing Practice
Ranbir Bains, PhD, APRN, CPNP
Carolyn Bradley MSN, RN, CCRN
Mental health disparities make up 16% of the global burden of disease and injury in people ages 10-19. Many cases of mental health are unidentified and left untreated. Failure to address mental health disorders in children can lead to poor outcomes of health and well-being. Evidence-based practice supports the utilization of screening tools such as the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adolescents ages 12-18 years.
By implementing the PHQ-9 in the pediatric emergency department, the goals for this quality improvement project were to increase staff knowledge on the PHQ-9, improve staff screening compliance, and to improve the identification of depression.
The Plan-Do-Study-Act (PDSA) model was utilized during the implementation and completion of this quality improvement project. From July 2021 to November 2021, staff nurses were educated on the PHQ-9 depression screening and then evaluated by a seven question pre- and post- test. Implementation of the PHQ-9 in the PED was then initiated and an evidence-based quality improvement algorithm was used to standardize treatment of patients scoring positive on the PHQ-9 in the PED. Based on the PHQ-9 algorithm and the overall score on the screening tool, specific resources were provided for the patient.
The overall objective to increase screening of patients in the PED at risk for depression was achieved. Although rates of documented depression screening increased from 0% to 28.95% over a four-month project timeframe, the goal of increasing screening rates to 50% was not reached. The 1:1 educational intervention increased staff knowledge about the PHQ-9 depression screening and the implementation process, meeting the educational objective of 100% of nurses staffed in the PED to be educated and trained on the PHQ-9 screening tool.
A ten-minute educational session with the project manager was determined to be successful as evidenced by the pre- and post-test results. Results depict an improvement in depression screening rates in the PED. Several advantages of this project were identified: ease of administering the tool, ease of documenting the scores through the patient's electronic health record, and low cost. Thus, the overall impact in screening those in the PED resulted in the identification and evaluation for depression in a population that had not previously been screened.
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Alvarez, C. (2022). Enhancing depression screening for the adolescent population in the pediatric emergency department by utilizing the patient health questionnaire: A quality improvement project [Unpublished DNP project]. Sacred Heart University.