NURS FPX 9010 Assessment 2

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