title:
Enhancing Depression-Risk Screening Among Post-Stroke Patients During Acute Hospitalization
creator:
Collins, Tracey
subject:
Dissertations, Academic.
description:
Providers frequently fail to identify depressive symptoms in elderly patients. National guidelines recommend routine formal depression screening for high risk adult populations such as those with any chronic condition; however, this is not consistently performed. The literature has identified that individuals with a history of major depression may have a 34% higher risk for developing a stroke compared to the general population. Therefore, based on high rates of undetected depression in the general elderly and higher stroke rates among adults with major depression, this project aimed to implement depression-risk screens during acute hospitalization to identify and initiate treatment for elderly patients admitted for a stroke or transient ischemic attack (TIA).For this project, focus groups were conducted to explore approaches staff nurses would propose to integrate a depression-risk screening tool into their electronic health record (EHR) and workflow. Based on results from the focus groups and a review of the literature, both education and system changes were implemented to support adult depression-risk screening and mental health referrals. As a result of this intervention, acute stroke and TIA patients were screened every shift by staff nurses, with the Patient Health Questionnaire-2 (PHQ-2) depression-risk screening tool, within 24 to 48 hours post-acute hospital admission. Patients with a PHQ-2 score of 2 or greater were offered a referral to a mental health counselor for further evaluation of depression.The focus groups identified seven themes to facilitate integrating a depression-risk screen into the nurse assessment and workflow. In the education intervention, 110 nurses completed web-based education of which 103 nurses also received face-to-face education. Test scores increased significantly between the pre-education (M=55.27, SD=15.5) and post-education tests (M=89.91, SD=11.3, t(109)=20.649, p=0.001. During the depression-risk screening intervention, 80% (n=36) of the nurses screened as indicated and 86.7% (n=26) of adult-hospitalized stroke patients received at least one depression-risk screen within the electronic health record. Of the patients screened, 15.4% (n=4) had positive results, 50% (n=2) accepted a mental health counselor referral, 50% (n=2) were prescribed an antidepressant at discharge, and 25% (n=1) declined referral or treatment, but accepted a chaplain consult for support. This project identified barriers and implemented interventions to facilitate the use of a depression-risk screen within the EHR for adult stroke and TIA patients in the acute hospital setting. As a result of this project, 86.7% of acute hospitalized adult stroke patients were screened, 15.4% had positive results, and 75% accepted an intervention. Of note, the positive results were lower than expected, thus further study should be conducted to evaluate staff nurse data collection methods.
publisher:
Simmons College (Boston, Mass.)
contributor:
date:
2014
type:
Text
format:
1 PDF (88 Pages)
identifier:
td_np_2014_tc
source:
language:
English
relation:
coverage:
rights:
Material from the Simmons University Archives collections are made available for study purposes only. For more information, or to request rights to reproduce or reuse any material, contact the University Archives at archives@simmons.edu.
