Staff Education to Implement Routine Use of Hamilton Depression Rating Scale on the Identification and Severity Classification of Adult Depression in Primary Care

This Doctor of Nursing practice (DNP) project was a quality improvement initiative focused on staff education to standardize the workflow and documentation of the Hamilton depression rating scale (HAM-D). The goal was to enhance measurement-based care and mitigate inconsistencies in depression severity assessments that could potentially delay treatment modifications, follow-up planning, and safety decisions. The practice-focused inquiry examined whether a concise staff education program, in conjunction with a HAM-D clinical practice guideline, would enhance staff knowledge and preparedness to administer and document the HAM-D for routine severity monitoring in adults exhibiting depressive symptoms. Employing rapid-cycle plan–do–study–act (PDSA) methodologies, five members of the primary care team underwent training on standardized administration/scoring anchors, considerations related to version measurement, interpretation of severity and changes over time, documentation requirements (total score, severity category, change, and plan), and protocol-based escalation procedures when suicidal ideation is reported, including a brief safety assessment. Outcomes were assessed using a five-item pretest and a corresponding five-item posttest, analyzed through descriptive statistics; mean scores increased from 2.8/5 (56%) to 4.8/5 (96%) (N = 5), signifying a heightened readiness to utilize HAM-D results in clinical actions and safety protocols. The primary deliverables included the draft HAM-D Clinical Practice Guideline/Screening Protocol and the Staff Training Outline/Materials. In summary, the project enhances nursing practice by refining severity monitoring, improving documentation quality, and facilitating care planning. The project has potential to enhance timely identification of severe symptoms for all patients.