Date of Conferral

8-26-2025

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Catherine Fant

Abstract

This DNP quality improvement project focused on addressing a critical gap in psychiatric care: the high rate of missed inpatient mental health visits. Missed follow-up appointments after hospital discharge are associated with medication nonadherence, relapse, hospital readmissions, psychiatric decompensation, and increased emergency department use. In severe cases, they may increase suicide risk. Contributing factors include patient-level barriers such as cognitive impairment, socioeconomic instability, stigma, low motivation, and transportation difficulties, as well as systemic issues like inadequate discharge planning and lack of standardized follow-up protocols. The evidence-based practice question guiding this project was: Will a clinical practice guideline (CPG) improve number of visits at mental health clinic? This DNP project aimed to develop and implement a nurse-led, evidence-informed CPG to enhance continuity of care. The CPG included interventions such as 24-hour short messages (SMS) and phone reminders, appointment cards distributed at discharge, and verbal reinforcement of the importance of follow-up visits. The CPG was evaluated by four expert reviewers using the AGREE II instrument. Mean scaled domain scores were Scope and Purpose (70.8%), Stakeholder Involvement (75.7%), Rigor of Development (69.3%), Clarity of Presentation (90.3%), Applicability (88.5%), and Editorial Independence (83.3%). Reviewers concluded it was evidence-based, feasible, and appropriate for integration, recommending adoption with minor enhancements such as same-day reminders and structured follow-up. The guideline shows strong potential to improve visit adherence, reduce readmissions, and support equitable, patient-centered psychiatric care.

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