Depression: Facility Assessment Checklists

Transcription

1 Depression: Facility Assessment Checklists A facility system assessment is a starting point for a quality improvement project. The checklists included in this booklet will be most useful if you take a critical look at your current practices. Directions for Depression: Facility Assessment Overview Questionnaire To be completed by a direct care or interdisciplinary team. Consult with appropriate staff in answering certain questions and completing checklists. If you answer to any of the questions below, please proceed immediately to the checklist referenced by the page after the question. If you answer to a question, the process is always complete and done so consistently. Please continue to the next question. If you answer In Progress to any of the below questions, the need is being addressed but needs improvement. Depression: Facility Assessment In Progress Does your facility have a process for when and how the staff will screen residents for depression? (page 2) Does your facility complete a comprehensive evaluation for depression after a resident scores positive for depression upon screening or at another time, if there is no screening process in place? (page 3) Does your facility have a process for developing and implementing care plans for depression for residents who have been identified as having depression? (page 4) For residents who are being treated for depression, does your facility have a process for monitoring or re-evaluating target symptoms of depression and determining if the resident s care plan is effective or needs revision? (page 5) Does your facility have a policy for assessment and management of depression? (page 6) Does your facility have initial and ongoing education on assessment and management of depression for all relevant caregiving staff? (page 7) When completing each checklist on the following pages: If you answer to all of the questions, the process is always complete and done so consistently. Continue to the next checklist. If you are not sure, or answer to one of the questions, choose one or more elements on which to focus your quality improvement. If you answer to one or more of the questions, the process is not always complete and/or not always done consistently. page 1 of 7

2 Depression: Screening A screening assessment is a brief assessment using a validated tool that determines if the resident is experiencing symptoms of depression. It does not include a thorough assessment of the resident s symptoms and does not diagnose depression. It does indicate that a thorough assessment needs to be completed if the resident scores positive upon screening. Does your facility s screening process include the areas listed below? Does your facility have a policy and procedure for when, how and whom (identify responsible staff) will screen residents for depression? Do you routinely ask all residents screened for adequate cognition to respond (using an appropriate tool such as 15-question Geriatric Depression Scale, the Cornell) about their depression symptoms at the following times? At admission At readmission At each MDS assessment With each change in condition Does your policy identify what is considered a positive screen? If the resident s screen is positive and/or he or she triggers the MDS elements suggesting depression, does your facility have a comprehensive evaluation process to diagnose depression? Are there procedures in place for discussing screening results with the resident s physician and care team?

3 Depression: Evaluation A comprehensive evaluation for depression is often done when someone develops new symptoms of depression or existing symptoms worsen, or the presence of depression is identified through another source, warranting a thorough assessment of the resident s status. Does your comprehensive evaluation process include the elements listed below? Does your policy and procedure state that residents should be evaluated for depression at the following times? At admission At readmission At each MDS assessment With each change in condition When the evaluation for depression is conducted, are the following elements included? Depressed mood (most of the day nearly every day) Anhedonia (markedly diminished interest or pleasure in almost all activities) Weight change (substantial unintentional weight loss or gain and nutritional status) Sleep disturbance (insomnia/hypersomnia nearly half the day) Psychomotor problems (psychomotor agitation or retardation nearly every day) Lack of energy (fatigue or loss of energy nearly every day) Poor concentration (diminished ability to think or concentrate nearly every day) Suicidal ideation (recurrent thoughts of wanting to die or suicide) History of depression symptoms and treatment Cognitive function changes Recent onset or worsening of medical conditions List of current medication (assess both prescription and over-the counter medications for their potential to alter cognition or mood) Stressors (pain, changes in social or family situation, recent losses, etc.) Are there procedures in place for discussing the results of depression evaluation with the resident s physician and/or care team? Does the procedure identify the staff (e.g., nursing staff, social work, physician, nurse practitioner) responsible for each component of the evaluation? After the depression evaluation is done are all these elements completed and recorded on your evaluation form? Does your procedure identify when a direct referral to (or evaluation by) the mental health professional should occur (e.g., suicidal ideation with or without demonstrated or verbalized plan to harm, presence of psychotic features)?

4 Depression: Developing Care Plans Does the care plan process include the areas below? Does the care plan for depression include a goal as defined by the resident/caregiver/ family member? Does the care plan include education of the resident and family related to these areas of depression management: Goal of therapy Side effects (if applicable) Overall treatment plan Does the plan consider psychosocial approaches to depression management (e.g., psychotherapy) and potential adjunctive strategies (e.g., exercise, activities)? Does the plan provide for a regular assessment (e.g., monitoring) of the resident s response to both pharmacologic and nonpharmacologic therapies? Does the plan outline when the monitoring reassessment of the resident s depressive symptoms will be completed? Does the plan identify when to refer to a mental health professional (e.g., residents with minimal or no significant improvement in depressive symptoms after 6 weeks of treatment)? Does the plan outline an approach (e.g., how, by whom) and a schedule (how often) for reassessing suicide risk?

5 Depression: Monitoring/Re-evaluation of Treatment Does your monitoring/re-evaluating process and care plan reviewal include these components? Do you have a policy and procedure defining when a comprehensive re-evaluation of the resident with depression will be completed? (Any persistent or worsening depression symptoms should receive a complete re-evaluation.) Does re-evaluation have all components in the comprehensive eval? Does your facility use appropriate method to monitor those with cognitive impairment for depressive symptoms (e.g., re-screen with Cornell/CSDD, Olin scale, staff observations)? Do you have a daily monitoring process for residents under assessment? Do you track the monitoring results in the medical record? Do you have a policy and procedure to measure resident and family satisfaction with your depression management? Is policy and procedure to re-evaluate depression followed when the resident exhibits persistent depression? the resident exhibits worsening symptoms? treatment for depression is intiated? Do you reassess residents taking depression medication to determine if they receive therapeutic doses needed to alleviate target symptoms? experience side effects? have drug interactions? Do you have a CQI or QA committee that routinely audits the depression management process?

6 Depression: Assessing Facility Policy Does your facility s policy for assessment and management of depression include the following components? Does your policy include a statement about your facility s commitment to management of depression (inclusion of physical, environmental, social and spiritual issues)? Does your facility s policy include screening, evaluation and monitoring of residents for depression? Does your policy include the goals of the assessment and management program for depression such as specification of appropriate depression screening tools for both cognitively intact and cognitively impaired residents? prompt assessment and diagnosis of depression? treatment techniques for depression based on evidence in the literature? steps to be taken to monitor treatment effectiveness? improving the resident s well-being and comfort by reducing the target symptoms of depression? optimizing the resident s ability to perform ADLs and participate in activities? monitoring for side effects related to the use of antidepressant medication (e.g., insomnia, anxiety, GI symptoms, headaches, dizziness)?

7 Depression: Facility Assessment Checklists page 7 of 7 Depression: Staff Training and Education Does your facility s screening process include the areas listed below? Are all new staff oriented in screening, assessment and management of depression? Are current staff provided with ongoing education on the principles of depression management? Does education staff provide discipline-specific education for assessment and management of depression (e.g., activities, dietary, rehab, social services)? Has the facility designated a clinical expert to answer staff s questions about depression assessment and management? Does education consider personal, ethnic, cultural and religious beliefs surrounding depression management? Is education provided at the appropriate level for the learner (e.g., CNA vs. RN)? Does education include staff training on how to document the essential elements related to depression (e.g., target symptoms that the resident exhibits, their frequency, environmental factors, goal of treatment plan)? Does your facility s education program include education on depression and its management for family? residents? Document available at MO DEP April 2006 This material was prepared by Primaris, the Medicare Quality Organization for Missouri, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.

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