Utilization of a Sleep Assessment Instrument at a VA Outpatient Mental Health Clinic

POSTER

Utilization of a Sleep Assessment Instrument at a VA Outpatient Mental Health Clinic Lindsey P Gavin, BSN, RN, DNP-PMHNP Student Amy Morton-Miller, DNP, APRN, PMHNP-BC, Kate Doyon, Ph.D., M.Ed., RN., CHPN, and Sara Webb, DNP, APRN, PMHNP-BC Key Findings: Psychiatric provider attitudes toward utilizing the Insomnia Severity Index during outpatient intakes improved in some areas after educational material was presented. However, ISI utilization remained low, and many providers cited barriers that inhibited implementation. Background Approximately 57% of veterans report sleep dysfunction compared to 30% of non-veterans. Veterans are at high-risk for PTSD, traumatic brain injury (TBI), chronic pain, and other mental health conditions; all of which lead to higher rates of insomnia. The Insomnia Severity Index (ISI) is a short, 7-question validated sleep instrument that is available in the VA's electronic medical record (EMR). However, it is infrequently used by providers and not well documented. This QI project aims to increase psychiatric provider use of the ISI by providing awareness of the prevalence of sleep dysfunction and by educating providers on the process of administering the ISI. Methods 37 providers were invited to participate in a preimplementation questionnaire to understand attitudes towards validated instruments to assess sleep dysfunction. 30 providers attended a presentation addressing the project aims. Post-presentation, the frequency of ISI use was collected over 84 days. A post-implementation questionnaire was given to assess changes in perspectives and practices toward ISI use. Agree or Strongly Agree Despite sleep disorders being common, many healthcare settings, including VA settings, do not routinely screen for sleep dysfunction. 100% Results Provider attitudes towards insomnia screener pre and post implementation training 80% 92.9% 66.7% 60% 92.9% 60.0% Pre-Questionnaire: • 40.5% (n=15) of providers completed the prequestionnaire. • Providers reported perceived barriers to ISI implementation as time, sleep as a secondary concern, and a lack of tool knowledge. 92.9% 60.0% ISI Implementation: • 5 out of 37 providers used the ISI. • ISI was utilized in 13 out of 143 intakes (9.1%) over 84 days. 40% 20% Post-Questionnaire: 0% • 37.8% (n=14) of providers completed the postConfidence in Confidence in ability Feasibility in questionnaire. diagnosing insomnia to track patients sleep implementing a sleep • Attitude improvements were observed in 3 categories: and sleep dysfunction screening instrument increased confidence in diagnosing insomnia and sleep Pre N=15 Post N=14 dysfunction, increased confidence in ability to track patients sleep, and increased feasibility in implementing a sleep screening instrument. • Time continued to be the most reported barrier (both perceived and actual) to ISI implementation. Barriers to ISI implementation as reported by providers • 10 providers endorsed plans to use the ISI in the future. Perceived Perceived Counts Counts Actual Barriers Counts Barriers in Pre- (%) Barriers in PostQuestionnaire N=15 Questionnaire 4 Time Time (26.7%) Sleep as a Secondary Concern Lack of Tool Knowledge Lack of Resources Patient NonCompliance No barriers stated 3 Lack of Tool Knowledge 2 Lack of Support No barriers stated (20.0%) (13.3%) 1 (6.7%) 1 (6.7%) 5 (33.3%) (%) N=10 4 (40.0%) in PostQuestionnaire Time 2 Patient NonCompliance 1 No barriers stated (20.0%) (10.0%) 3 (30.0%) (%) N=4 2 Conclusions (50.0%) During the implementation phase, providers minimally used the ISI. Provider perceptions of barriers may have factored 2 (50.0%) into ISI use. 1 Barriers to ISI use could be mitigated through additional (25.0%) support from staff, mandated departmental screening, and patient completion prior to their appointment. Future projects should assess both provider-facing and patient-facing barriers to ISI completion. Increased education about the positive outcomes associated with simultaneous treatment of sleep and psychiatric disorders is also needed. COLLEGE OF NURSING