Implementation of the Patient-Health Questionnaire-9 (PHQ-9) Depression Screening Tool through the Nursing Discharge Process with Stroke Patients: A Quality Improvement Project
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Date
2020-12
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Publisher
The Ohio State University
Abstract
Introduction: Poststroke depression (PSD) is a common and detrimental condition affecting one-third of
hemorrhagic and ischemic stroke survivors. Current guidelines recommend screening early in the stroke
recovery period, with some suggesting it best to screen patients prior to discharge from the hospital.
Purpose: The primary purpose of this qualtity improvement project was to determine if shifting
administration of the inpatient depression screening from the stroke care coordinator to the nursing staff
affected the number of overall missed (22.1%) and weekend-specific depression screenings (37%) for
stroke patients at the author's institution. Methods: Total number of stroke admissions compared to the
number of completed depression screenings, total number of depression weekend screenings, total
number of positive depression screenings, and total number of psychiatric referrals were compared pre
and post intervention. A Likert scale-based survey along with two open-ended questions were
administered to the nursing staff to determine whether there was a change in nursing knowledge about
post stroke depression in addition to acceptability, feasibility, and qualitative feedback about the process
change. Results: No statistically significant differences were noted in the total amount of missed
depression screenings (22.1% vs. 18.8%), the amount of missed weekend screenings for depression (37%
vs. 15.6%), or the number of psychiatric referrals (4.7% vs. 4.7%) in the pre and post implementation
periods. Nurses' knowledge about post stroke depression increased and the process change was well
received. Conclusions: Administration of the depression screening by the nurses did not significantly
change the number of overall or weekend depression screenings. The low number of positive screenings
and psychiatric referrals in the immediate inpatient setting calls into question whether screening for
depression this early is necessary and highlights the need for depression screenings at multiple points of
care.
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Keywords
Depression, Screening, PHQ-9, Stroke, Rehabilitation, Nurse