Implementing Standardized Depression Screening in Long-term Care: A QI Project

Older adults, particularly those in long-term care facilities, face challenges accessing resources as they age, increasing their risk for mental health disorders. Risk factors such as social isolation and declining health, compounded by comorbidities, often contribute to undiagnosed depression. Despite its prevalence, depression screening in these facilities is not standard practice, as evidenced by a literature review revealing barriers like time constraints and stigma surrounding the diagnosis. Local Problem: Routine depression screening remains irregular in long-term care facilities, with barriers including time constraints, dementia, and stigma. Given the population's susceptibility to mental health disorders, screening should be standard practice. This aids in the development of well-equipped clinicians to manage these disorders. Methods: Utilizing the Johns Hopkins Evidence-Based Practice Model, routine depression screening was implemented in nursing homes. A demographic survey collected participant data while screening rates were assessed pre-implementation and 30 and 60-days post- implementation. Provider training and a clinical practice guideline were provided to aid in depression management. Pre- and post-implementation surveys gauged provider confidence and clinical practices. Interventions: The project focused on implementing routine depression screening using the PHQ-2 screening tool. Provider training increased awareness of mental health disorders among nursing home residents. A clinical practice guideline from the American Psychological Association was adapted to include local resources. Usability and satisfaction were assessed through pre- and post-surveys. Results: Evaluation of screening rate data revealed a significant increase from 16% to 48% post- implementation. A chi-square test confirmed a statistically significant rise in screening rates after implementation. Providers reported the clinical practice guideline's usefulness and the feasibility of standardized depression screening in this population. Overall satisfaction with the project was high, as indicated by survey data presented using descriptive statistics. Conclusion: This project successfully improved the clinical process of depression screening in long-term care facilities. Findings demonstrated the utility of the clinical practice guideline, the feasibility of standardized screening, and provider satisfaction. Addressing barriers to routine screening and enhancing provider awareness are critical steps in improving mental health resources for older adults in long-term care settings.