NURS FPX 9010 Assessment 3

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