Date of Award

Fall 2020

Project Type

Clinical Doctorate

College or School

CHHS

Department

Nursing

Program or Major

Doctor of Nursing Practice

First Advisor

Jessica Hatch

Second Advisor

Debra Fournier

Abstract

Background: At this time there is no standardized education for providers of New Hampshire Hospital addressing the Revocation of Conditional Discharge Process. Psychiatric patients in New Hampshire most at risk for harm to self or others are managed through Involuntary Commitment Orders. These orders are intended to support those most at risk of destabilization and treatment non-compliance. The Revocation of Conditional Discharge Process is one of the procedures used to re-hospitalize a patient whose care is managed through an Involuntary Commitment Order when needed. The psychiatric providers at New Hampshire Hospital must complete this last step in the revocation process, the Absolute Revocation. Each portion of the revocation process submitted to the Legal Office must be valid and legally sound. Patterns have been noted in which the steps to revoke a Conditional Discharge fail to be completed appropriately, thus jeopardizing the process and patient care. In FY 2019, per data collected and analyzed by the Legal Office of New Hampshire Hospital, 89% of appealed Absolute Revocation cases were not upheld when those reversed on appeal and those that were withdrawn due to fatal error were included. In FY 2020, 73% were not upheld. A failed revocation results in the inability to continue hospitalization by this process, placing patients and providers at risk.

Purpose: The global aim of this initiative will be to improve compliance with the steps of the Revocation of Conditional Discharge process in order to decrease risk of reversal of appealed Absolute Revocations. The initial pilot of this quality improvement project will aim to improve provider knowledge and mastery of completing the Absolute Revocation process by implementing an e-learning module developed to educate the providers at New Hampshire Hospital about each of the steps necessary for compliance.

Methods: A project plan was developed after a review of the available knowledge using Roy’s Adaptation Model and the Institute of Medicine's Core Competencies as the foundation and framework to guide development, implementation and assessment of an educational module specifically designed to address knowledge deficits to improve compliance and mastery of the steps of the process at New Hampshire Hospital.

Interventions: An educational module was developed to provide comprehensive education regarding all steps in the Revocation of Conditional Discharge Process, with a focus on the steps and timelines of the Absolute Revocation portion of the process. Pre and post-tests were designed and utilized to assess the level of knowledge and mastery of the process steps.

Results: Seven participants completed the module, pre- and post-test in the set time frame, statistical significance for effectiveness of the learning module was found when pre and post-test scores were analyzed using paired t-tests.

Conclusion: Although not all targets outlined in the specific aim were met, the educational module and tests were found to be statistically significant even with the small sample size. This educational project can now serve as the foundation for future education regarding the process and related care needs and issues to key individuals across the care continuum.

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