Date of Graduation

Fall 12-11-2020

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions




Family Nurse Practitioner

First Advisor

Dr. Juli Maxworthy

Second Advisor

Dr. K.T. Waxman


Problem: In January 2019, a medium-sized acute care hospital in Northern California reported new safety concerns related to patients using illicit substances in the hospital.

Context: Leaving the hospital AMA is an increasing problem in acute care hospitals among patients who use illicit substances, with a rate of 25% to 30% (Ti & Ti, 2015). Grewal et al. (2015) conducted a study of over 1,000 illicit substance users who had experienced a hospitalization, where 43.9% reported use of illicit substances while in the hospital.

Intervention: The project was the creation, implementation, testing, and evaluation of multiple interventions to improve patients' safety who use illicit substances in an acute care hospital and for the staff who care for them. Collectively, the interventions will be referred to as the toolkit.

Measures: To assess and measure the effectiveness of training provided to staff, the Thackrey Confidence in Coping with Aggression instrument with pre and post-assessments was utilized. Knowledge acquisition of the concept of implicit bias was measured pre and post-education. Comfort level or self-assuredness of nurse leaders was measured pre and post-education and simulations. A survey measured stakeholders' overall satisfaction with the toolkit. Reduction in risk reports of safety concerns regarding this patient population was tracked and measured.

Results: There was a 94% reduction in the number of risk reports related to safety while over 200 behavior contracts have been administered. There was a 20.5% improvement of the level of self-assuredness of the contract's nurse leader administration, or p-value <.005. The comfort and confidence level of staff improved with statistical significance in nine out of ten measures on the Thackrey instrument. The overall level of satisfaction of the toolkit was measured at 7.29 on a Likert scale of 1-10.

Conclusions: The toolkit provided effective strategies to mitigate risks associated with this patient population. The ongoing support and sponsorship for a project that crosses department and service line boundaries are in place to assure sustainability.