Date of Conferral

8-4-2026

Date of Award

August 2026

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Donna Bailey

Abstract

This Doctor of Nursing Practice project was a quality improvement staff education initiative focused on improving suicide risk screening and documentation in an outpatient psychiatric clinic. Inconsistent use of validated screening tools and documentation practices created risks for missed identification of patients at risk for suicide. Addressing this gap was essential to improve patient safety and support evidence-based behavioral healthcare. In the project, I examined whether implementing standardized suicide risk screening with staff education would improve screening and documentation consistency over 12 weeks. The purpose was to increase staff knowledge, screening compliance, and documentation accuracy. Pre- and postimplementation chart audits, compliance monitoring, knowledge assessments, and participant feedback surveys were employed. I used descriptive statistics to evaluate changes following implementation. Results showed improvements in staff knowledge, screening compliance, and documentation consistency, supporting standardized screening and education as effective strategies for improving patient safety and quality of care. Project products included the staff education, standardized screening workflows, and documentation tools. Based on the results of the project, I concluded that these interventions improved practice consistency, with ongoing education, competency validation, and compliance monitoring recommended for sustainability. The project also supports evidence-based nursing practice and promotes positive social change, diversity, equity, and inclusion by helping ensure equitable suicide risk screening for all patients. Background Suicide remains a significant public health concern and is among the leading causes of preventable death worldwide. Healthcare organizations play a critical role in identifying patients at risk and implementing timely interventions to prevent adverse outcomes (The Joint Commission, 2023). National patient safety initiatives emphasize the importance of routine suicide risk screening in behavioral health settings using validated assessment tools (The Joint Commission, 2023). An assessment of organizational practices within the project site outpatient psychiatric clinic identified inconsistent suicide risk screening and documentation procedures. Screening practices varied among providers, resulting in differences in assessment quality and documentation completeness. Variability in practice can contribute to missed opportunities for early identification of suicide risk and may negatively affect patient safety outcomes (Melnyk & Fineout-Overholt, 2019). The project question was: In adult patients receiving care in an outpatient psychiatric clinic, how does implementation of standardized suicide risk screening with staff education, compared to current practices, affect staff knowledge, screening and documentation consistency over a 12-week period? The purpose of the project was to improve adherence to evidence-based, suicide risk screening practices through implementation of validated screening tools and staff education. Organizational readiness assessments demonstrated leadership support and recognition of the need for workflow standardization. Stakeholder engagement activities identified providers, nurses, and clinical leadership as essential participants in successful implementation (Huber & Joseph, 2026). Current evidence supports the use of standardized suicide screening tools to improve early identification of individuals at risk for suicide. The Columbia-Suicide Severity Rating Scale and Patient Health Questionnaire-9 have demonstrated effectiveness in improving the consistency, reliability, and accuracy of suicide risk assessment (Bissett et al., 2025). Research also supports staff education as an effective strategy for increasing provider knowledge, improving adherence to evidence-based guidelines, and strengthening documentation practices (Melnyk & Fineout-Overholt, 2019). Furthermore, implementation science literature emphasized that education, leadership engagement, and workflow integration are essential components of sustainable practice change (White et al., 2024). The evidence supporting this project was derived from national patient safety recommendations, evidence-based practice literature, implementation science research, and studies evaluating suicide risk screening tools and educational interventions. Collectively, the evidence demonstrated moderate-to-strong support for the use of standardized screening instruments, staff education, leadership engagement, and workflow integration to improve screening accuracy, documentation quality, and patient safety outcomes. The consistency of findings across multiple evidence sources strengthened confidence in the project intervention and supported implementation within the outpatient psychiatric setting. Staff Education Project Development In this project, I used the Johns Hopkins evidence-based practice model to guide project development, implementation, and evaluation (see Bissett et al., 2025). The project was focused on addressing identified practice gaps through staff education and implementation of standardized suicide risk screening protocols. Participants included providers, nurses, and clinical staff responsible for conducting patient assessments and documenting clinical findings. I developed the educational content for the project using current evidence-based guidelines and recommendations related to suicide prevention and risk assessment (see The Joint Commission, 2023). Training materials included PowerPoint presentations, educational handouts, workflow guidance documents, and standardized documentation templates. The intervention involved implementation of validated suicide risk screening tools, including the Columbia-Suicide Severity Rating Scale and Patient Health Questionnaire-9, into routine clinical practice. Educational sessions addressed appropriate administration of screening tools, interpretation of results, documentation standards, patient safety considerations, and referral processes for individuals identified as being at risk (see Bissett et al., 2025). Staff received instruction through structured educational sessions, reinforcement activities, and ongoing support from leadership and project stakeholders. Evidence suggests that standardized assessment tools improve clinical decision-making and reduce variability in practice (Melnyk & Fineout-Overholt, 2019). Therefore, I implemented workflow integration strategies to ensure screening occurred consistently across patient encounters. Leadership support, communication, and stakeholder engagement were used to facilitate implementation and encourage staff participation (see Huber & Joseph, 2026). Evaluation methods included pre- and postimplementation chart audits, compliance monitoring, and staff feedback surveys. Data collection focused on screening completion rates, documentation consistency, staff confidence in conducting suicide risk assessments, and knowledge acquisition following the educational intervention. I collected evidence through review of patient records, staff knowledge assessments, and participant evaluation surveys. Data analysis involved descriptive statistical comparisons of baseline and postimplementation measures to evaluate changes in screening compliance, documentation completeness, staff knowledge, and confidence levels. I summarized the findings and compared them to project objectives to determine the effectiveness of the intervention and identify opportunities for sustainability (see White et al., 2024). Results Five clinical staff members participated in the educational intervention and completed all training requirements. Evaluation of project outcomes included pre- and postintervention knowledge assessments, chart audits, compliance monitoring, and participant feedback surveys. Outcome measures were focused on suicide risk screening compliance, documentation completeness, staff knowledge, staff confidence, and participant satisfaction. Implementation outcomes demonstrated substantial improvement across all project measures. As shown in Table 1, suicide risk screening compliance, staff knowledge, documentation completeness, and staff confidence improved following implementation of the staff education intervention and standardized suicide risk screening workflow. Baseline chart audits demonstrated that suicide risk screening compliance was 40%, indicating that only 4 of 10 eligible patient encounters contained completed and documented suicide risk assessments using appropriate screening methods. Following implementation of the staff education program and standardized screening protocol, compliance increased to 90%, with 9 of 10 eligible patient encounters demonstrating completed and properly documented suicide risk assessments. This represented a 50-percentage-point improvement in adherence to evidence-based suicide risk screening practices. This improvement also reflects greater consistency in documentation and enhanced staff competency in suicide risk assessment. Table 1 Project Outcome Measures Before and After Implementation Outcome measure Baseline Postimplementation Suicide screening compliance 40% 90% Staff knowledge assessment score 68% 94% Documentation completeness 50% 95% Staff confidence (5-point scale) 2.8 4.8 Staff reporting improved knowledge N/A 100% Staff satisfaction with training N/A 100% Staff reporting improved workflow efficiency N/A 80% Note. N = 5 clinical staff members. Baseline measurements were collected prior to implementation of the staff education intervention. Postimplementation measurements were collected following completion of the 12-week implementation period. Staff knowledge also improved following the educational intervention. The average preeducation knowledge assessment score among participants was 68%, which increased to an average posteducation score of 94%, representing a 26-percentage-point improvement in knowledge related to suicide risk screening, documentation requirements, use of validated assessment tools, and appropriate follow-up procedures. Documentation accuracy improved substantially during the implementation period. Baseline chart audits revealed that only 50% of completed suicide screenings contained all required documentation elements, including screening results, risk stratification, clinical decision-making, safety planning, and follow-up recommendations. Following implementation, documentation completeness increased to 95%, demonstrating improved consistency and adherence to organizational standards. Staff confidence in conducting suicide risk assessments also improved. Using a 5-point Likert scale, participants reported an increase in self-rated confidence from an average score of 2.8 before training to 4.8 after training. Additionally, 100% of participants reported that the educational intervention improved their understanding of suicide risk assessment procedures as well as enhanced their ability to appropriately document findings and implement follow-up interventions when indicated. Participant satisfaction with the educational program was high. All five staff members indicated that the training was relevant to their clinical practice, easy to understand, and beneficial to patient care. Four of the five participants (80%) reported that the standardized workflow improved efficiency and reduced uncertainty regarding screening and documentation procedures. The project positively impacted the organization by increasing standardization of suicide risk assessment practices, reducing variability among providers, improving documentation quality, strengthening patient safety efforts, and promoting compliance with evidence-based recommendations. Staff feedback suggested that the use of validated screening tools and standardized documentation templates improved workflow consistency and facilitated more effective communication among members of the interdisciplinary team. Several limitations should be considered when interpreting project findings. The project was conducted in a single outpatient psychiatric clinic with a small sample size of five staff members, limiting the generalizability of results. Additionally, the implementation period was limited to 12 weeks, preventing evaluation of long-term sustainability and patient outcome measures. Staff scheduling constraints and competing clinical priorities may also have influenced participation and implementation consistency. Despite these limitations, the project successfully demonstrated that implementation of standardized suicide risk screening combined with staff education can improve staff knowledge, screening compliance, documentation accuracy, and confidence in conducting suicide risk assessments. The findings have significance beyond the local practice setting because suicide risk assessment is a critical component of patient safety across healthcare environments. The intervention may be adapted for implementation in other outpatient behavioral health clinics, primary care settings, and healthcare organizations seeking to improve suicide prevention efforts, strengthen evidence-based practice, and enhance patient safety outcomes. Conclusions This Doctor of Nursing Practice project successfully addressed a practice gap involving inconsistent suicide risk screening and documentation practices within an outpatient psychiatric clinic. Implementation of standardized screening tools and staff education improved screening consistency, documentation quality, and staff competency. The findings support previous evidence indicating that educational interventions are effective strategies for promoting adherence to evidence-based practice recommendations (see Melnyk & Fineout-Overholt, 2019). The project demonstrated the importance of leadership engagement, interdisciplinary collaboration, and ongoing education in achieving sustainable practice change (see Huber & Joseph, 2026). Continued support from organizational leadership will be necessary to maintain improvements and ensure long-term sustainability of the intervention. My recommendations include annual competency validation, periodic chart audits, continued staff education, integration of suicide screening protocols into new employee orientation, and expansion of standardized screening processes to additional clinical settings. Future projects should evaluate the long-term sustainability of the project outcomes and explore the relationship between standardized screening practices and patient outcomes. The project’s implications for nursing practice include improved identification of individuals at risk for suicide, enhanced patient safety, greater consistency in clinical decision-making, and increased utilization of evidence-based assessment strategies. Positive social change may occur through earlier intervention, improved access to mental health services, and the reduction of preventable adverse outcomes. Additionally, standardized screening promotes diversity, equity, and inclusion by ensuring all patients receive consistent and evidence-based suicide risk assessment regardless of demographic, cultural, or socioeconomic characteristics (see American Association of Colleges of Nursing, 2021).

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