A quality-improvement initiative: implementation of a screening process for eating disorders in outpatient psychiatry

Abstract

Eating disorders (EDs) are one of the most life-threatening and disabling mental health conditions and have a significant prevalence in men and women of all ages worldwide. Despite their severity and improved treatment outcomes with early identification, EDs are not frequently disclosed by patients or proactively screened for by many medical providers. ED screening is an effective, safe, quick, and cost-effective way to assess for the presence of EDs, allowing for further medical provider evaluation. An outpatient psychiatric setting is an optimal place to screen for EDs due to the concurrence of these with other mental health conditions treated in this setting. The Doctor of Nursing Practice (DNP) quality-improvement (QI) project aimed to implement within the outpatient psychiatric clinic setting an ED screening process using the Eating Disorder Examination-Questionnaire Short (EDE-QS), focused on enhancing nursing processes with nurse mentoring and psychiatric mental health nurse practitioner (PMHNP) assessment. A 6-week implementation period took place between January 3, 2022, and February 11, 2022, including a participating PMHNP and their scheduled patients. The following procedures took place: (1) Stakeholders were educated on the DNP process and purpose by the DNP student; (2) The clinic front desk staff gave each patient an EDE-QS screener at check-in to be completed with other screening tools already utilized by the provider; (3) The patient brought these completed screeners back to the registered nurse (RN) upon nursing intake; (4) The RN scored the EDE-QS screeners, and positive screeners, scores of 15 or greater, were given to the PMHNP by the RN at patient hand-off; and (5) The PMHNP had the opportunity to further assess for EDs during the visit and manage the ED, if present, at the PMHNP's discretion, either by managing in the outpatient psychiatric clinic or by referring to an ED treatment center. Findings paralleled literature that described the EDE-QS as an effective screening tool for EDs and suggested that mentoring and education of nurses, along with pre-implementation process development, can standardize workflow and the integration of new screening processes into practice.