An Institute of Medicine (IOM) report introduced five core competencies for healthcare providers: providing patient-centered care, working in interdisciplinary teams, employing evidence-based practices , apply quality improvement, and use information technology (Institute of Medicine of the National Academies, 2003). The goal of the report was to improve the U.S. healthcare system. The IOM proposes that if all five key competencies are used by healthcare professionals, quality patient care can be achieved. Integration of evidence-based practice To implement a new screening system for depression, all clinical staff will be trained on the importance of recognizing depression in hemodialysis patients. Furthermore, all members of the interdisciplinary team will have a clear understanding of their role in this new screening procedure. The tool selected in the screening process is BDI. For current patients, the initial screening process will be performed chairside when the nurse performs the pre- or post-hemodialysis assessment. New patients, however, will be selected during the hospitalization process. Once the initial screening has taken place, patients will be screened again every six months. According to Battistella (2012), the most effective way to recognize the early onset of depression is to perform screening when the patient first starts dialysis, so every six months or every year. In a recent study by Keskin and Engin (2011), using the BDI, they found that 40.2% of participants with kidney failure suffered from depression. The study confirmed that depression increases significantly with age and with a lower level of education. Furthermore, suicidal ideation is more evident in this patient population and increases with the severity of... middle of paper... ...have symptoms of depression, however, they fail to recognize their symptoms and/or believe the need for treatment is not necessary. Due to the prevalence of depression in ESRD patients and decreased quality of life, screening for depression is essential in hemodialysis centers. The most used tool in clinics and research to evaluate depression is the BDI; the BDI not only assesses depressive affect, but also assesses cognitive content (Keskin & Engin, 2011). The survey includes 21 questions: two questions on emotions, 11 on cognition, two on behavior, five on physical signs and one on interactive signs. Questions are scored on a scale of zero to three, with a total score ranging from zero to 63. A score below nine indicates no or minimal depression, 10 to 18 mild depression, 19 to 29 moderate depression, and greater than 30 severe depression.