Publication:

A quality improvement project to improve mental health screening at nurse triage in a primary healthcare center

Background One-fifth of adults attending primary care have a diagnosable mental disorder, which is in top 10 diseases of global burden. Screening for early detection of mental and substance misuse disorders in primary care can improve quality of life. The screening percentage was low at 86% for mental health. So, QI project undertaken to improve mental health triage at health center using a staff reminder strategy and refresher training at individual level, as these have shown effectiveness in systematic reviews.

Methods The project employed plan-do-study-act (PDSA) cycles to test the change ideas. Quality improvement tools, including process mapping, Fishbone analysis, driver diagrams, and prioritization matrices, were used to identify root causes and develop interventions and refresher training of nurses were the change ideas.

Results The refresher education session was attended by 42 nurses and 52 nurses received regular emails on update and reminder on first week of each month and weekly social media messages throughout the project period. Mental health triage asking for PHQ2 and GAD2 questionnaire by triage nurses improved significantly during the project period of 3months from the baseline values of 84% to 94% for depression and from 88% to 97% for anxiety.

Conclusions Mental health triage in primary care health centers can be improved by increasing its awareness in triage nurses and their attitude towards mental health. Mental health screening can be improved by refresher training and reminders. Collaboration and teamwork between nurse and administration team will deliver an excellent outcome.