Improving Effective Depression Screening and Care in an Inpatient Substance Use Disorder Treatment Facility.

Abstract

Background: Depression affects approximately 280 million people worldwide. In the United States, about 33% of adults with major depressive disorder abuse substances, and the economic burden is approximately $237 billion. Research recommends universal screening in the adult population. Objectives: The aim of this project was to improve effective depression screening and care in patients with substance use disorder, review the existing literature, audit patients' charts to identify gaps, analyze data, draw conclusions, and make recommendations. Methods: Four Plan-Do-Study-Act quality improvement cycles were implemented over 8 weeks. Two core interventions were used to improve depression screening and increase effective care. Two tests of change (TOC) occurred each cycle, and qualitative and quantitative data were collected and analyzed for the next TOC. Results: Depression screening and effective care increased to 88% from a baseline of 13%. Depression screening improved to 95%, with 90% of positive patients reporting mild to severe depression. Overall, 82% of patients received effective care. Conclusions: Effective depression screening and care improved with team and patient engagement, early intervention, following guidelines, and best practices. Sustaining effective depression management will require utilizing evidence-based interventions to reduce the high depression positivity rate. Implications for Nursing: As mental health gatekeepers, universal depression screening and appropriate referrals for continuity of care are recommended to reduce disease burden.