Increasing the Effectiveness of Depression Screening and Management in Patients With Substance Use Disorder

Background: Substance use disorders (SUD) are common in depression. When left untreated, depression can result in impairment, reduced treatment adherence, and poor outcomes. A chart audit at an outpatient addiction center revealed a 28% depression screening rate. Objective: This quality improvement initiative aimed to increase the effectiveness of depression screening and management to 90% in 8 weeks in patients with SUD. Methods: Two core interventions were implemented during four 2-week cycles to identify patients with depression and ensure effective care implementation. After each cycle, run charts were analyzed to steer tests of change. The Patient Health Questionnaire (PHQ-9) was utilized to screen and identify patients with depression, and an effective care tool (ECT) was implemented to measure effective care provided. Results: After examining 391 encounters and 236 chart audits, the interventions increased the effectiveness of depression screening and management to 81%. Checklists helped increase screening rates to 95%, and provider huddles increased the effective care score to 95% overall. Conclusions: Implementing the PHQ-9 and ECT increased the effectiveness of depression screening and management and was sustainable through quarterly chart audits. Implications for Nursing: The recommended next steps include company-wide staff training with mandatory modules, systematizing workflow, embedding electronic PHQ-9 forms into the electronic medical record, creating electronic prompts, training center managers on routine chart audits utilizing the ECT, and creating an online depression toolkit to scale the framework to other clinics.