NURS FPX 9000 Assessment 3 Topic Report with CITI Training

Student Name 

Capella University

NURS-FPX9000

Professor Name

Submission Date

Topic Report with CITI Training

The continuity and the best response to the treatment among psychiatric patients can be supported by the follow-up compliance with outpatient telepsychiatric services and preventing a relapse. However, in the case of most outpatient psychiatric centers, there are issues concerning lack of follow-ups on patients, which influence the treatment process and increasing the rates of emergency care use (Hugunin et al., 2023). Psychiatric practice has nurses as its key player in follow up on patients and inclusion of patients on treatment schemes.

It is anticipated that the quality improvement project can prepare the nursing staff in a primary care facility to support a telepsychiatric follow-up plan, based on automated reminders services. The project aims at enhancing the following up procedures of the nursing personnel to warrant or lead to at least 15 percent improvement in following up adherence to bring the rate nearer to the national level.

Project Problem and Relevant Evidence

The identified issue in the outpatient psychiatric practice is the lack of follow-up adherence in patients undergoing the telepsychiatry services. According to baseline data on the project site, only 55% of the patients were found to attend scheduled follow-ups, a figure that is way lower than the required 80% figure of maximum continuity of psychiatric care (Clinical Director, personal communication, November 3, 2025; Hird et al., 2024). The gap suggests that there is an urgent necessity of a systematic protocol that will provide an increased adherence to follow-ups.

The issue is a complicated group of patients with depression, anxiety, bipolar disorder, and other persistent psychiatric diseases, most of whom must have medication and symptom control readjusted on a regular basis. The clinic works with 40- 60 patients per week, and because of the absence of a standardized follow-up system, their monitoring is typically conducted irregularly, medicines are not observed, and significant changes in the treatment plans are delayed (Clinical Director, personal communication, November 3, 2025).

The problem under consideration requires a prompt solution as the number of missed appointments has been growing as more telepsychiatry is used. Since the clinic is overly relying on virtual visits, the problem increases the vulnerability of the patients to lack of engagement with the care since there is no reminder system in place and/or standardized monitoring (Clinical Director, personal communication, November 3, 2025). It has been shown that more efficient digital reminders and telehealth-based follow-up guidelines are related to a much higher adherence and no-shows (Brancewicz et al., 2025). As such, the presented automated reminders and an evidence-based follow-up protocol make the project aligned with the existing behavioral health programs focused on the proactive approach and digital care coordination.

The continuity of care and consistent patient engagement is a problem of paramount importance in an outpatient mental health environment. The follow-up adherence rate established within the project, which is at 55%, the rate of missed appointments, and the rate of the outreach required to reschedule are some of the site-specific metrics of the project that verifies that the measurable problem has been recognized (Clinical Director, personal communication, November 3, 2025). The signs all lead to the discontinuity of care. Without solving the problem, the clinic will face a threat of continued inefficiencies, violated patient safety, and worsened clinical outcomes (Clinical Director, personal communication, November 3, 2025).

The site requires the project because the organization does not have an official data-driven plan to track patient engagement, and the staff members still has to use the manual system of follow-ups, which is unsustainable and requires time (Clinical Director, personal communication, November 3, 2025). An automated system that is standardized is appropriate to be implemented that guarantees an increase in the operational efficiency and patient engagement as well as long-term treatment outcomes.

Impact on Individuals and Stakeholders

The non-adherence related to the lack of follow-ups has a direct effect on several stakeholders in the outpatient psychiatric facility. Lack of attendance to follow-up medical visits results in delayed medication modification and symptom exacerbation in addition to increasing the risk of relapse to patients with chronic psychiatric illnesses such as depression or bipolar disorders (Thimmaiah and Nayok, 2020). It was found that a mismatched psychiatric follow-up results in more emergency department visits, recurrence of symptoms, and, eventually, unsuccessful treatment outcomes (Cousineau et al., 2024).

In the case of telepsychiatry patients, the barriers can also be the difficulties with utilizing telepsychiatry technology and low levels of health literacy. Regarding the organizational aspect, low follow-up rates may be considered as an obstacle to the smooth workflow of patient shifting in a centralized model (Thimmaiah & Nayok, 2020). Being a small practice with 40-60 patients a week, the no-show rate is not regularly high, which poses an organizational issue in a small practice environment with limited capacity to deliver high-quality, patient-focused psychiatric services.

Recognizing Potential Areas for Improvement or Additional Knowledge

The site obviously has to put into place systematic health promotion and follow-up programs targeting a geriatric population. At present, there are no standard interventions being developed around health literacy and self-management of aging adults who have risk factors of chronic diseases (Clinical Director, personal communication, November 3, 2025). The red flag of 48% compliance is an approximation, but the finer detail would be more useful in targeting, such as stratifying disease, risk group, or health literacy level.

Measuring health literacy and treatment burden, e.g., through a treatment burden questionnaire among the older patients of the clinic, would enable a deeper understanding of the barriers and would make it possible to frame interventions with greater accuracy (Selvakumar et al., 2023). The other possible effective interventions are the establishment of a self-management program, led by nurses, on the basis of the effective intervention models. 

The Project Site

The location of the project is a separately owned outpatient psychiatric clinic. This is an urban-based organization in the state of New York, and it also has telepsychiatry services. The facility is an outpatient clinic that focuses on diagnostic, psychotherapeutic, pharmacological, and follow-up care to adult patients with mental illnesses such as depression, anxiety, and bipolar disorders (Clinical Director, personal communication, November 3, 2025). The clinic operates on a small staff of workers that has up to five support employees, namely, the psychiatric nurse practitioner, other therapeutic employees, and some auxiliary employee members who handle the scheduling and billing. Psychiatric continuity and follow-up of patients are assisted by two psychiatric nurse specialists (Clinical Director, personal communication, November 3, 2025).

The outpatient mental health clinic is present on the project site, and this particular clinic also administers telepsychiatry services as one of the intervention strategies targeting outpatient psychiatric facilities, which, in turn, becomes even more efficient with the Covid-19 pandemic and thus, it is getting even more efficient in increasing the access to outpatient psychiatric services (Clinical Director, personal communication, November 3, 2025). The mentioned features of the site render the organization appropriate to the project.

The location functions in a diverse urban community, whereby the outpatient mental health needs are predominant and may be influenced by the socioeconomic and structural determinants that could impact adherence to the follow-up appointments (Clinical Director, personal communication, November 3, 2025). It was demonstrated that the number of no-shows and follow-through gaps in appointments is higher in urban outpatient clinics than in other healthcare environments (Chou et al., 2021).

Concerning the implementation, it is important to mention that at the moment, the clinic is serviced by 40-60 patients a week, which consists of 30 in-person and 10-30 remote visits. The number might, however, change based on the availability of providers and the timetables of telepsychiatry. Despite all the advantages of the telepsychiatry services, there are factors that have been found to undermine the completion rates. Such factors consist of technological and unreliable engagement challenges related to telepsychiatry.

Potential Implications of the Project Site for the Project

There are several implications to the nature of the outpatient psychiatric facility that could influence the initiatives toward enhancing the rate of adherence to follow-up. Although telepsychiatry was reported to have a high rate of successful completion as compared to regular and physical visits, issues related to digital literacy and internet connectivity should be properly addressed (Ettman et al., 2023).

A lean and close-knit staffing system may facilitate faster adoption and optimization of interventions, i.e., automated reminder systems and routine follow-up practices, and enable the clinic to successfully absorb changes. Since forgetting, fluctuation, and ambivalence are common issues in outpatient psychiatric patients, it has been shown that the reminder processes, such as text messaging, will enhance attendance (Low et al., 2021). In general, the site and patient demographics and size, combined with the practice model, can present an ideal environment to test telepsychiatry-enhanced interventions geared towards enhancing continuity and outcome. 

Project Support at the Project Site

The site has been favorable to the project. The project preceptor is quite important and occupies a high-level position as an outpatient behavioral health clinical manager. It was also planned to be updated regularly, including discussions with various stakeholders on a regular basis, i.e., weekly and bi-weekly basis. The sample consisted of the required organizational representatives on-site, including the medical director of psychiatry, the nurse supervisor, the telehealth coordinator, and the quality improvement (QI) specialist. It is also essential to get feedback from the stakeholders to make some improvements in the areas that can be improved (Maurer et al., 2022).

Several changes were brought up, such as the issues dominating at the site to be pursued, the feasibility of having an automatic reminder system, data gathering, and staff education required. Participants also provided necessary updates and suggestions, such as that the staff needs to receive required training about the changes at the site and create reminders that would be more culturally and technically acceptable to less digitally competent patients. 

Proposed Interventions

There are evidence-based interventions required to improve the quality of care. The project intervention also revolves around the U.S. Community Preventive Services Task Force (CPSTF) suggested structured telepsychiatry follow-up system and an automated reminder system (Centers for Disease Control and Prevention, 2024). The tele psychiatry follow-up system shall incorporate mechanisms that promote patient compliance in addition to minimizing the no-show rates. It will involve booking patients to receive follow-up calls, automated reminders by using text messages or emails, online symptoms tracking, and an outreach policy in instances where patients do not turn up.

It will begin by creating an effective telepsychiatry follow-up system that is integrated into an electronic health record (EHR) system. The tele psychiatry will lead to reminders 24 hours and 72 hours prior to meetings. Automatic confirmations and accessible rescheduling systems will be involved in automated reminders. Before patients can visit telepsychiatry sessions, they will be asked to take a short check-in with a digital symptoms assessment, which will generate timely data to design individual treatment courses for patients. 

The plan, do, study, and act (PDSA) cycles will be used to implement the telepsychiatry project with an attempt to apply the mechanisms and immediate knowledge to modify and improve the system. Much evidence can be presented regarding the intervention. The outpatient group (psychiatric disorder) randomized controlled trial by Low et al. (2021) showed that structured mobile message reminders were effective in terms of achieving higher attendances (76.8) than usual treatment (56.4). On the same note, a study by Brancewicz et al. (2025) indicated that automated short-message service (SMS) message reminders considerably decreased the number of no-shows in a mental clinic and hence was found to be of value as an intervention tool to benefit its customer base on patient retention and the use of mental health services. Opon et al. (2020) objectively assessed the number of outpatient facilities that used automated message reminders and quantified the overall effects of the method in reducing missed service appointments by an average of 41%.

Besides, the formal inclusion of digital daily alert and planning reminders through mental health mobile support tools has been shown to benefit active mental health task and strategy abides (Hamlin et al., 2023). In addition, Swati and Sharma (2025) demonstrated that mobile applications and telepsychiatry services can be used to enhance engagement, clinical adherence, and attendance of patients during appointments. The educational aspect will concentrate on the provision of education/staff programs among the psychiatric nurses, administrative personnel, and the psychiatric nurse practitioner. Interactive workshops will be held that are more oriented to the follow-up strategy, automation and alert reminders, document requirements, and integration with symptom monitoring. Although training will allow the staff members to have hands-on experience with the system, competence testing will allow a precise and consistent implementation process. The educational intervention plan among the staff members is crucial to ensure that the staff members are confident and able to improve the telepsychiatry strategy on follow-up.

Comparisons

The project will be compared to the existing normal care. The state is described as having an inefficient and non-standardized follow-up system applied ad hoc with non-formal patient reminders and an approximate follow-up compliance rate of 55 percent (Clinical Director, personal communication, November 3, 2025). An automated telepsychiatric follow-up system with proactive staff outreach would, in its turn, represent desired-state health care. Researchers have found that automated messaging results in high outpatient and medication adherence, with outpatient rates increasing significantly at 76.8% vs 56.4% when standard approaches are used (Low et al., 2021).

It was found out that teleinformatic approaches have reduced the rate of no-shows by a great margin of 18.6 at baseline versus 7.0, so these approaches are obviously more effective (Brancewicz et al., 2025). The intervention will be universal among the participants in the project, so a control group will not be implemented. The measure of changes will be based on pre- and post-implementation measures, using the protocols that will rely on such measures as follow-up rate, no-show rate, and rationed clinical endpoints as the measures of attaining a desirable state compared to the current state.

Desirable Outcomes

The objectives of the quality improvement project that can be desirable are the measurable indicators of the adherence of the patients to the follow-up. The desirable outcomes of the project aim at enhancing patient follow-up adherence after eight to ten weeks of the initial or past encounter. Increased adherence to follow-up care of the patients is the major result of the project. The standards of the baseline data reflect low adherence to follow-up care, with the patient adherence rate being 55 percent, which is considerably lower than 80 percent of the national measure (Clinical Director, personal communication, November 3, 2025; Hird et al., 2024).

Combining automated electronic health record-based reminders, the objective is to elevate adherence to follow-up. Follow-up adherence will be a measure of the outcome as it will be determined through the extraction of EHR scheduling and encounter data to determine whether patients have visited for a completed visit in 8 10 weeks since their last appointment. Since the main channel through which follow-up with patients occurs is the nurses, they will be instrumental in this enhancement (Chan et al., 2022). It is aimed that the follow-up adherence rate can be increased at least by 15% and features a more comparable number of 80 as the national average. Taken together, not only do the results prove the efficacy of the intervention, but they also guarantee the further continuity of psychiatric care and better clinical outcomes within the framework of outpatient telepsychiatry.

Learner’s Role for the Project

The learner has a role to play as a project leader by supervising the entire project of the telepsychiatry follow-up care improvement. In the project, the learner will be involved in supervising the data collection process, maintaining compliance with the intervention, and collaborating with my preceptor as a project mentor. The learner will organize the planning of projects and complete project aspects as part of organizational objectives. The learner will play the role of staff education and setting up the standardized follow-up practice and telehealth project, such as telehealth project staff and information technology personnel, during the project implementation, concerning their configurations and implementations of automated reminder systems. The learner will be in charge of monitoring and troubleshooting compliance rates and will take all means of communicating with all parties interested.

Meanwhile, the learner will be in charge of monitoring and arranging regular data gathering and implementation modifications in accordance with the emerging project data. The preceptor will also be the project supervisor to the learner and will authenticate the project decisions and grant the project access to the required personnel and resources as the learner performs the project tasks daily on their own. 

Project Question

P: How does the introduction of a standardized telepsychiatry follow-up protocol using automated reminder systems suggested by CPSTF (I), as opposed to the existing practice (C), influence the rate of patient follow-up (O) in 12 weeks (T)?

The target population (P) includes the workforce of an outpatient telepsychiatry clinic composed of nursing staff. The intervention (I) is standardized follow-ups of telepsychiatry that is conducted with automated reminder systems suggested by the CPSTF team (Centers for Disease Control and Prevention, 2024). The comparison (C) implies the existing care practices with no standard adherence protocols. The outcome (O) is centered on the adherence levels of the patient follow-up. The time (T) includes a 12-week implementation time. A review of five evidence-based research studies on the implementation of the intervention is presented in the literature matrix in Appendix B.

Conclusion

The issue of follow-up compliance in telepsychiatric practice is one of the areas that needs attention and priority on the need to improve continuity and maximize the outcome of the mental health practice. With the effort to simplify the follow-up practice via an automated reminder system, optimization of patient follow-through and inclusion in the practice would be simpler for nursing staff. Being a concentration on patient practice optimization, the QI project is aimed at both responding to the current issues regarding follow-up compliance and advancing a focus on encouraging an optimal and sustainable pattern regarding patient inclusion and practice.