NURS-FPX9010

NURS FPX 9010 Assessment 3 Project Proposal Student Name Capella University NURS-FPX9010 Doctor of Nursing Practice 2 Professor Name Submission Date Project Proposal It is essential that outpatient telepsychiatric services be an integral part of aftercare in order to provide continuity of care, optimize treatment outcomes, and reduce the risk of relapse for psychiatric patients. Many outpatient psychiatric services are also hampered by the inconsistent follow-up of patients. This problem negatively affects treatment outcomes and increases the utilization of emergency services (Hugunin et al., 2023). The independent outpatient psychiatric clinic where the project is being implemented has a 25% baseline rate of patients following up within 30 days after an appointment, which is significantly less than the national standards, which are 35.3% within 7 days and 50.7% within 30 days of an encounter (Simple Practice EHR dataset, Nov. 03, 2025, internal site; Medicaid.gov, 2026). There is an increasing level of telepsychiatry, and due to an absence of a consistent system of reminders or follow-up, patients will likely become disengaged from the clinic (Clinical Director, Nov. 3, 2025, personal communication). The project’s PIOCT is: In an outpatient telepsychiatry clinic (P), what is the impact on patient follow-up adherence rates (O) from implementing a telepsychiatry follow-up protocol with a reminder system, as recommended by the CPSTF (I), compared to current practices (C), within a period of 12 weeks (T)? This quality improvement project aims to provide the nursing staff of the telepsychiatry unit with an evidence-based telepsychiatry follow-up protocol, with reminders, and offers a goal of increasing follow-up adherence to a minimum of 20%, thereby improving continuity of care and outcomes for clients. Practice Problem The practice problem identified for the practicum site arose from the November 2025 electronic health record data regarding the 30-day follow-up. This data indicated a 30-day follow-up adherence rate of 25%, whereas the national average was 50.7% (Clinical Director, personal communication, November 3, 2025). Several issues related to the practicum site processes were identified, including a) the absence of a systematized reminder process, b) a predominantly manual and opportunistic follow-up process, and c) a lack of engagement with patients post-telepsychiatry session. The clinic treated 40-60 patients per week, and even though there was some use of telepsychiatric services, it still had the problem of patients dropping out of care. The clinic had around 40 to 60 patients per week, and there was some usage of telepsychiatry, but no efforts to ensure continued engagement, which led to patients being lost. The local problem echoed the general pattern of the nation, which was recorded in literature. There was still a problem with initial adherence in settings, with studies showing 59.4% of psychiatric outpatients had completed timely return visits within 30 days (Chen et al., 2022). Additionally, less than 10% of the patients of state-funded facilities received recommended follow-up within 30-days of discharge (Hermer et al., 2021). The results highlighted the importance and need for systematics in the context of patient follow-up in psychiatric care settings. One of the most basic elements of good healthcare – all day, everywhere – is continuity of care. Since the start of the COVID-19 pandemic, mental health issues across the country have worsened, and research has proven that psychiatric complications, such as anxiety, depression, cognitive deficits, and even the development of psychiatric diseases, have been observed after COVID-19 infection (Taquet et al., 2021; Poletti et al., 2021; Taquet et al., 2022). Sadly, national-level data show troubling trends – the number of outpatient mental health visits and the number of psychotropic medications used by adolescents and young adults have almost doubled from 2006 to 2019, reflecting growing mental health needs and the growing demand for psychiatric services (Horst & Bourgeois, 2024). Mental health service use was markedly impacted by the pandemic: providers reported major changes in the number of contacts with patients, and a rise in the number of consultations regarding post-COVID syndromes (Czeisler et al., 2021; Fehr et al., 2024). Access to early outpatient follow-up (OPT) post psychiatric discharge was shown to have a significant effect in reducing suicide risk, especially by patients with substance use disorder, schizophrenia, bipolar disorder, and depression (Ee et al., 2023). Treatment engagement was improved with effective care management programs, but barriers such as transportation issues, financial instability, and lack of availability of mental health professionals remained in all settings. Project Site The project site is a privately owned outpatient psychiatric clinic located in an urban environment. As an ambulatory organization, its primary focus is on the provision of assessment, psychotherapy, use of psychiatric medications, and follow-up services to adult patients with mental illness whose primary symptoms include depression, anxiety, and bipolar disorder. (Clinical Director, personal communication, November 3, 2025). The outpatient mental health clinic has 5 or fewer support staff, a psychiatric nurse, therapeutic staff, and staff who help with scheduling and billing. There are 2 psychiatric nurse specialists who assist with patient follow-up and psychiatric continuity. (Simple Practice EHR dataset, internal site, November 03, 2025). The clinic draws an attendance of 40-60 patients a week, 30 of whom receive services in the clinic, while 10 to 30 receive services through teletherapy. The clinic is located in a diverse, urban community. It is likely that outpatient mental health services are needed by a high proportion of the community’s residents. Socioeconomic and structural barriers in the community may limit levels of follow-up. Project Fit for DNP Site This site makes an ideal choice as part of the DNP practicum for various contextual and organizational reasons. The clinic’s increasing reliance on telepsychiatrists since the Covid-19 pandemic provides an ideal opportunity to install the practice-based, evidence-synthesized digital reminder, along with the structured follow-up procedures (Clinical Director, personal communication, November 3, 2025). The small size and integrated nature of the clinic’s staff greatly contributed to the adoption, development, and further refinement of the procedures. The clinic’s location in the inner city and its range of clientele, coupled with the persistent problems of OPPs of forgetfulness, variability, and ambivalence, suggest that reminder

NURS FPX 9010 Assessment 2 Project Proposal Student Name Capella University NURS-FPX9010 Doctor of Nursing Practice 2 Professor Name Submission Date Project Proposal Outpatient telepsychiatric services are important for continuity of care, maximizing response to treatment, and preventing psychiatric patients’ relapses, and must be followed up on. But, due to the lack of consistent follow-up by patients, the treatment outcomes are poor, and there is an increase in the use of emergency services (Hugunin et al., 2023). Baseline data at the project site, an independently owned outpatient psychiatric clinic, showed 25% follow-up within thirty days, which is significantly lower than national standards of 35.3% follow-up within seven days, and 50.7% follow-up within thirty days (Simple Practice EHR dataset internal site, November 03, 2025; Medicaid.gov, 2026). Continuity of care is a major concern, especially within the context of the clinic’s use of telepsychiatry, where patients are at a higher risk of disengaging without a standardized reminder system and monitoring protocols (Clinical Director, personal communication, November 3, 2025). What is the impact on patient follow-up adherence in a 12-week period of implementing a standardized, CPSTF-recommended telepsychiatry follow-up protocol with a reminder system versus the current outpatient telepsychiatry practice by nursing staff? The purpose of the quality improvement project is to provide nursing staff with a telepsychiatry follow-up protocol following our evidence that will reach at least 20% improvement in adherence to the follow-up protocol, which will increase continuity of care and outcomes as a result of the follow-up services. Practice Problem To identify gaps in healthcare delivery, a proper assessment of existing practices and results is needed. The practice problem was recognized through baseline data analysis of electronic health records in November 2025, demonstrating that patient follow-up within 30 days of their scheduled appointments had a rate of 25%, which was lower than the national average of 50.7% (Clinical Director, personal communication, November 3, 2025). The deficient processes at the practicum site consisted of no standardized reminders, manual follow-up procedures by staff that have been inconsistent based on availability, and no established protocols to be followed after a telepsychiatry appointment to assist in engaging patients after their visit. The clinic treated about 40-60 patients per week, and there was an increasing dependence on telepsychiatry, which increased the risk of patient dropout, as there were no proactive measures in place to reach out to and monitor patients. The local problem was in line with national trends that have been reported elsewhere. Poor initial adherence was still a problem at any level, and studies found that only 59.4% of psychiatric outpatients returned in time, within 30 days (Chen et al., 2022). In addition, less than 10% of patients in state-funded facilities had recommended follow-up care within 30 days of discharge (Hermer et al., 2021). The findings highlight the importance of a systematic approach in ensuring follow-up of patients in psychiatric care settings. Continuity of care is one of the key elements of good care in all healthcare environments. The COVID-19 pandemic has intensified mental health issues across the country, as studies have reported psychiatric consequences of the infection, such as anxiety, depression, cognitive impairment, and psychotic disorders (Taquet et al., 2021; Taquet et al., 2022; Poletti et al., 2021). The demand for psychiatric care has increased, since there was a worrisome trend in national data, with almost a doubling of the number of mental health-related outpatient visits and psychotropic medication use among adolescents and young adults between 2006 and 2019 (Horst & Bourgeois, 2024). The pandemic dramatically reshaped the way that mental health was used, especially with providers noting large changes in the number of contacts they had with patients and the rise in consultations for post-COVID syndromes (Czeisler et al., 2021; Fehr et al., 2024). Ee et al. (2023) found that early outpatient follow-up after psychiatric discharge had a significant negative effect on the risk of suicide, especially for substance use disorders, schizophrenia, bipolar disorders, and depression. Whereas effective care management programs showed improvement regarding treatment engagement, there remain barriers in all healthcare settings, such as transportation issues, financial instability, and limited availability of mental health professionals (Druss et al., 2021). There is a need to continue to tackle the underlying issues (systemic issues) with evidence-based interventions to continue to improve quality outcomes in behavioral health. Project Site The project site is an independently owned outpatient psychiatric clinic in an urban setting. It is an ambulatory facility that focuses on providing diagnostic, psychotherapeutic, pharmacological, and follow-up services to adult clients with mental illness, such as depression, anxiety, and bipolar disorders (Clinical Director, personal communication, November 3, 2025). The clinic has a small staffing network consisting of no more than 5 support employees, such as a psychiatric nurse practitioner, multiple therapeutic employees, and an on-demand auxiliary for scheduling and billing. Patients receive support from two psychiatric nurse specialists, both with follow-up and psychiatric continuity (Simple Practice EHR dataset, internal site, November 03, 2025). The clinic receives about 40-60 patients per week, with an average of 30 patients visiting in person and 10-30 remote visits per week, and is situated in a diverse urban community with a large number of outpatient mental health needs, where patient adherence with follow-up services may be influenced by socioeconomic and structural factors. Project Fit for DNP Site This project is well-suited for the DNP practicum site for several reasons relating to organizational and contextual considerations. Since the clinic has switched to a higher proportion of telepsychiatry services after the COVID-19 pandemic, there is a great opportunity for the system of digital reminders and structured follow-up interventions to be put in place (Clinical Director, personal communication, November 3, 2025). Its small and integrated staffing structure makes it simpler to incorporate and adapt interventions and enables the clinic to make changes without having to go through lengthy bureaucratic procedures. The ambulatory psychiatric patients at the site also have various common barriers to treatment, such as forgetting, fluctuation, and ambivalence, consistent with evidence that interventions such as reminders (text messaging) have