Date of Award

Spring 5-3-2024

Document Type

DNP Project

Project Team Faculty Member

Beth McCoy

Project Team Faculty Member

Tracy Cooley


skilled nursing, senior living, mental illness, rehospitalizations, hospitalizations, behaviors


Skilled nursing facilities are an essential component of the continuum of care and, with the rapidly aging population, represent an increasing cost to the healthcare system. The policies beginning in the 1960s promoting the deinstitutionalization of mental health institutions have resulted in increasing numbers of individuals with serious mental illnesses now residing in skilled nursing facilities. The complex needs of individuals with mental illness have been associated with an even greater cost of care, deficient quality, and safety concerns. This quality improvement project analyzed the impact of an evidenced-based, structured behavioral intervention checklist on rehospitalization rates in individuals with mental illness residing in a skilled nursing facility. The checklist was designed to allow nurses to use an algorithmic methodology to deescalate the manifestations of mental illness to prevent rehospitalization. Staff were provided with education on the management of residents with mental illness and the use of the checklist throughout the process. Data was collected pre- and post-implementation of the checklist to measure 90-day rehospitalization rates with a secondary measure reviewing lost census days to hospitalizations. The checklist showed limited improvement in 90-day rehospitalization rates (p < 0.04). Lost census days to hospitalization showed a more robust improvement (p < 0.01). While more research would appear warranted, the implications of these findings suggest that checklists or algorithms may be a viable care improvement tool in complex care environments such as skilled nursing facilities.

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