Relapse Prevention through Quality Standards for Depression Kristine

Relapse Prevention through Quality Standards for Depression Kristine Lorbergs and Kristine Leggett Michael Garron Hospital Problem Statement Some patients with Major Depression admitted and discharged from MGH, relapse and return to the emergency department, resulting in readmission. This impacts the hospital though wait times & costs, and patients’ quality of life. One contributing factor is inconsistent, only oral education on how to fully manage their symptoms in the community. Aim Statement All adults who have an admission for MDD will be offered consistent education and information on major depression. Diagnostics • We are a community hospital setting • After completing a departmental needs assessment we chose to focus on our 40 bed inpatient unit • A focus group and a questionnaire with inpatients diagnosed with MDD validated their needs • A staff questionnaire on group and individual teaching on MDD related topics identified gaps • Documentation audits were completed to verify how much patient education was being completed (very little was being recorded by any discipline on inpatient unit) Charts Intervention/Change Ideas Early success: MDD Education Groups: Lifestyle Comparison Grid, Medication, Personal Medicine, Nutrition, Sleep Toolkit for 1: 1 Education using “teach back” methodology with printed resources: Crisis, Signs and Symptoms, Medication, Coping Strategies Spread Scale up MDD education to include • Other language resources • Open outpatient discharge transition group for MDD and anxiety • Child & adolescent appropriate resources Explore co-offering a depression focused community group with network partners Expand what is working on inpatients to include other diagnoses Measures Outcome measure: % of patients with MDD that receive standard education prior to discharge Key process measures: Documented education by group or individual teachback. Topics included medication management, relapse prevention, crisis planning and goals and coping strategies. Organizational Enablers Program director met with us for support on a regular basis. VP of patient services also met with us and was very encouraging of the project Results During IDEAS 1. Groups focused on identified needs in HQO MDD standard 11 were planned and implemented. 2. Nursing staff trained and mentored in leading groups through participation and supervision. 3. Individual “toolkit” handouts tested, prepared and used with patients. 4. Staff trained in teach-back methodology of patient education. 5. Qualitatively: i. staff were positive regarding the focus of something specific to discuss with patients ii. Patients had positive feedback about the group topics and individual toolkit “Sharing relevant experiences about depression in group was helpful. ” “I had the time to do this instead of just talking with the patient. I liked that it gave us a structure to talk through. ” Invited to speak about project at department huddles and council meetings to increase communication and garner suggestions Next Steps/ Lessons Learned • Improve data gathering with IT for groups • Continue to develop staff skills until they are comfortable running groups on their own • Increase library of offered groups in line with current best practices • Lesson learned: • MDD was too narrow a focus for our client population, to be sustainable, we needed to include to other diagnoses as well • there is so much depth to making effective and sustainable changes! Sustainability Our biggest challenges to sustaining the changes: • On average on 15% of our adult inpatients have a primary diagnosis of MDD – meaning that staff forget to do education kit and groups become exclusive if only target a small population • Unit is very busy and acute leaving staff limited time • Very little dedicated time and 2 person team Solutions? • Remain ongoing with PDSA cycles: o Continue to mentor staff o Visual memory joggers o Daily Huddle reminders/discussion about who is ready for education Contact Name: Kristine Lorbergs Title: Advance Practice Nurse Organization: Michael Garron Hospital Email: Kristine. Lorbergs@tehn. ca Phone: 416 -469 -6580 ext 6320