Hyman 707 In your peer responses, offer suggestions and other thoughts for your colleagues to consider. 1, Responds to this post in half a page use different reference to response please Many inmates are admitted to the psychiatric hospital in clinical practice due to suicidal attempts and self-injurious behavior without screening for depressed mood. Lack of screening is a significant factor preventing providers from recognizing and addressing depression. Hence, a lack of awareness of depressive symptoms inhibits diagnosis, treatment, intervention, and prevention of suicide attempts. Implementing a protocol for depression screening utilizing the PHQ-9 tool at admission and follow-up healthcare visits in the prison system can reduce the negative impact of depression The are several expected outcomes resulting from implementing the depression screening protocol. The first outcome is increasing the rate of utilization of the PHQ-9 at admission. The second expected outcome is increasing the use of the PHQ-9 to measure the severity of depression symptoms for treatment monitoring in the new and existing diagnosis of depression. Finally, each consenting inmate will be evaluated with the PHQ-9 upon admission to the psychiatric hospital. The results will be recorded in the medical record, and the provider will assess the patient and determine the appropriate treatment. Then, the inmate will be reassessed in two weeks with the PHQ-9. The admission and the follow-up screening results will be recorded on a data collection tool for comparison. The literature strongly supports the use of the PHQ-9 for depression screening. Sun et al. (2020) indicate that PHQ-9 shows reliability, validity, and adaptability for clients with depression in a psychiatric hospital. Sun et al. (2020) selected 109 patients who met the inclusion and exclusion criteria completed the PHQ-9 and HAMD-17. The intraclass correlation coefficient between the PHQ-9 and HAMD-17 score was (95% confidence interval, , P 65 years to select a proxy to share goals, wishes, preferences and complete an advance directive to facilitate end-of-life decision making. What outcomes do you feel are important to measure? And how do you propose to go about it? If you are using a standardized tool, please tell us the reliability and validity of the instrument. Outcome 1. To determine if there is an increased screening rate of ACP education after the intervention Outcome 2. To determine if there is an improvement in the completed number of AD in the EHR. ACP education has been in existence at the practice experience (PE) site. The current method indicates that the provider offers brief, unstructured, and unfacilitated ACP education to patients with terminal illnesses, chronic medical conditions, and those nearing end of life. The provider and team members are to be assessed for knowledge, purpose, benefit, related terminology, appropriate timing, roles (provider, patient, proxy), and comfort in offering ACP education (Quality improvement for institutions, .). After IRB approval, a PowerPoint presentation will be given to the team during the clinic staff meeting with virtual access for members who cannot attend in person. The project’s purpose and steps for the ACP educational interventions, from patients’ screening to AD completion, will be discussed. The current practice of ACP education falls below the standard and metrics for delivering quality care by the Institute of Medicine (IOM), according to Harris et al. (2020), decreasing the national lower rate of AD completion. This is the first study done about ACP education in this clinic, and there is no past comparative data. A Pre and Post chart review method with a quantitative, exploratory design through a retrospective data collection will be used for this project. Patient information from the clinic’s EHR will be used as the source of data collection, and personal identifiers will be removed to maintain patient’s privacy Currently, the clinic has no established screening tool to assess patients Pre and Post ACP education or readiness to complete AD. Screened patients who are deemed to meet the eligibility criteria for ACP education will be educated. A 9-item ACP engagement survey tool will be kept in the chart and used to screen for inclusion criteria and assess the readiness to engage in ACP education and willingness to complete AD and after ACP educational intervention. Sudore et al. (2017) postulated that this tool has an internal consistency of and high construct validity that can predict change in response to an ACP intervention. A valid test is also reliable (Harris et al., 2021). What benchmarks (please be specific, such as a 20% increase in knowledge) have you selected to evaluate your project on? Internal? External? Are they reasonable given your projects are short-term, only implemented over 10 weeks? A cross-section of adults > 65 are currently being screened and have AD completed in the clinic. The chosen intervention of ACP education should screen all adults > 65 in the clinic to increase improve ACP participation and completion of AD to a goal of at least 75 percent of patients. This project’s outcome will exceed the internal benchmark compared and exceed the metrics set by other organizations. This goal is feasible because the organization’s strengths, weaknesses, opportunities, and threats will be identified, and the clinic staff will be trained. Team buy-in will be gained prior to implementation. The data collection process will commence after obtaining IRB approval from Chatham University IRB clearance. The clinic staff will be instructed to begin implementing the usual ACP education and document and upload AD in EHR three months prior to the project implementation phase to collect pre-implementation data from EHR. Post-implementation data will be collected from the patients’ EHR after the 10 weeks of project implementation, and the data will be protected from bias and loss or theft. The readings for this week are examples of published Quality Improvement studies. (Sometimes, reading works for structure and mechanics is helpful because we are distanced from the content directly related to our project.) Discuss insights obtained on how the authors navigated the problem, intervention, chosen outcomes, and benchmark-setting. Problem: In the study implementation of the vulnerable elders’ survey-13 by Vernon et al. (2019) the researchers emphasized the importance of aligning the researches problem with the mission. The chosen problem should meet the internal and external benchmarks and exceed the current or existing practice metrics. Intervention: The researchers noted that the chosen intervention should be reliable and valid. The VES-13 screening tool was chosen among other older adult screening tools due to its conciseness and simpleness. The PACU staff found the VES-13 screening tool helpful and easy to use; they disagree with its usefulness and critical application to practice. The chosen intervention did not align with the goals of the organization. The researchers also noted that there was a problem with the project design. The VES-13 screening tool was not incorporated into the patients’ EHR, and this contributed to data loss, lowering the number of anticipated data for the study from 103 to 48. The researcher noted that frontline error may have affected the data collection process. Chosen outcomes: The researchers shared that the outcome of a project should align with the organization’s goals. The chosen screening tool (VES-13) was intended to identify patients’ risk for post-op complications requiring perioperative anesthesia consult. This implies the screening tool’s reliability to effectively-identified functional defects among older adults planning surgery. The tool did not align with the organization’s goal for a screening tool to identify patients at risk for Post-op increased level of consciousness, change in mental status, and morbidity. Benchmark-setting: The authors could not recommend practice change from the project because the screening tool was reliable but lacked validity. The screening could not estimate or compare the screening test result to other relevant data used previously in the organization. Therefore, the screening tool did not meet the intended goal of the organization. Using a model framework could have allowed the identification benchmarking from the beginning. References Harris, J., Roussel, L., Dearman C., & Thomas, P. (2020). Project planning and management. A guide for nurses and interprofessional teams (3rd ed.). Jones & Barlett Learning, LLC. Hirakawa, Y., Saif-Ur-Rahman, K. M., Aita, K., Nishikawa, M., Arai, H., & Miura, H. (2021). Implementation of advance care planning amid the COVID-19 crisis: A narrative review and synthesis. Geriatrics & gerontology international, 21(9), 779–787. Institute of Medicine (IOM). (2014). Dying in America: Improving quality and honoring individual preferences near the end of life. Report%20Files/2014/EOL/Report% McMahan, ., Tellez, I., & Sudore, . (2020). Deconstructing the complexities of advance care planning Outcomes: What do we know and where do we go? A scoping review. Journal of the American Geriatrics Society, 69. Sudore, R. Updates in ACP measurement and evidence-based patient-facing tools. https// Quality improvement for institutions. (.). Advance care planning tool kit. Vernon, T. L., Rice, A. N., Titch, J., Hill, B. F., & Muckler, V. C. (2019). Implementation of vulnerable elders survey-13 frailty tool to identify at-risk geriatric surgical patients. Journal of PeriAnesthesia Nursing, 34(5), 911–. https://do