Care ZoningA Pragmatic Approach to Enhance the Understanding of Clinical Needs As it Relates to Clinical Risks in Acute In-Patient Unit Settings

Abstract

The process of risk assessment which should inform and help identify clinical needs is often seen as a tick box and task-focussed approach. While on the surface this provides a sense of security that forms have been completed, we often fail to communicate in a meaningful manner about the clinical needs identified, which would assist in supporting the care planning delivery processes. A clinical practice improvement (CPI) project implemented a care zoning framework as an evidenced-based process that provides pragmatic support to nurses who are required to continually assess, implement, and evaluate plans to address clinical need across three acute mental health inpatient settings. Risk descriptors informed by the New South Wales (NSW) Mental Health Assessment & Outcome Tools (MHAOT) criteria were developed and described in behavioural contexts in order to improve the project's reliability and translation. A pragmatic traffic light tool was used to share clinical information across three agreed care zones, red (high clinical need), amber (medium clinical need), and green (low clinical need). Additionally nurses were asked to utilise a shift review form in the context of supporting the recording of care zoning and promoting action-orientated note writing. The introduction of care zoning has enthused the nursing teams and the mental health service to adopt care zoning as a supervisory framework that increases their capacity to communicate clinical needs, share information, and gain invaluable support from one another in addressing clinical needs. This includes increased opportunities for staff to feel supported in asking for assistance in understanding and addressing complex clinical presentations.

Risk assessment and subsequent nursing interventions in a forensic mental health inpatient setting: Associations and impact on aggressive behaviour

“…There has been limited investigation into the impact of nursing interventions that are used to prevent and manage aggression (Irwin, 2006), and little guidance as to the most effective methods, resulting in uncertainty for nurses (Stevenson, Jack, O'Mara, & Le Gris, 2015). Therefore, the selection and implementation of preventative strategies often occur in the absence of a framework that would assist in providing pre-emptive and targeted interventions before the aggression becomes imminent (Taylor et al, 2011). Without a systematic approach, the interventions used may lack consistency, or be unsuitable for the patient or the situation (Daffern et al, 2007), and may lead to the use of reactive and restrictive practices (Taylor et al, 2011).…”

Evaluating the impact of an electronic application of the Dynamic Appraisal of Situational Aggression with an embedded Aggression Prevention Protocol on aggression and restrictive interventions on a forensic mental health unit

“…Uncertainty regarding suitable aggression prevention interventions may also lead to uncertainty in practice (Stevenson et al 2015). Consequently, such as limit-setting, de-escalation, and administration of PRN medication may be applied in the absence of a framework that could assist in providing pre-emptive and targeted interventions before aggression escalates (Taylor et al 2011). In regard to the studies that have structured nursing interventions following assessment using a validated risk assessment instrument, it remains somewhat unclear how the nursing interventions were selected, for example if they were selected based on empirical evidence, and if there was any investigation into when to apply these interventions according to the level of risk assessed (see Abderhalden et al 2008;Daffern et al 20092009;van de Sande et al 2011).…”

Australian College of Mental Health Nursing 37th International Conference –‘Mental Health Nursing: Swimming between the flags?’

“…METHOD A 3 month pilot was conducted in a PICU within a regional mental health facility. The Care Zoning protocol was adopted from the original work of Ryrie et al (1997) and more recently implemented programs in the literature (Guy & Henderson, 2004;Gamble, 2006;Gamble et al, 2010;& Taylor et al, 2011). Site visits to a centre already utilising Care Zoning were conducted, and a working party was formed to modify the protocols for local use.…”