Multidisciplinary health professionals' assessments of risk: how are tools used to reach consensus about risk assessment and management?

Abstract

'This is the peer reviewed version of the following article: GERACE, A., CURREN, D. and MUIR-COCHRANE, E. AbstractRisk assessment and management are among the most important and complex tasks health professionals undertake in their practice to prevent harm to patients and ensure safe and effective treatment. The aim of this study was to examine how multidisciplinary team members use tools to assess and manage risk, through examination of how tools are used to gather, record and "score" risk information; and how this process impacts on the formulation of risk assessment and management plans, interaction with patients, and consensus with colleagues regarding patient care. Fourteen professionals completed an assessment for a hypothetical client using a risk assessment and management tool, and then discussed their assessment in semi-structured interviews. Professionals were in moderate agreement in their assessments of the client on the tool, and highlighted the complexity of their decision making.Clinical management decisions, such as the amelioration of particular risks, followed assessment of the patient in a consistent way. The tool was an important way to for clinicians to communicate their judgments to others and set plans to direct patient care. Implications for the use of clinical decision making tools and instruments in mental health care, and the need for a focus on multidisciplinary decision making, are highlighted.

Survey of mental health nurses' attitudes towards risk assessment, risk assessment tools and positive risk

“…, Gerace et al . ). Conversely, others proposed that they facilitate discussion between practitioners about risk and enhance care documentation (Muir‐Cochrane et al .…”

“…In relation to risk assessment tools, only one study was located that reported nurses using validated tools or derivatives to guide their practice (Godin 2004); while some of the Community Mental Health Nurses (CMHNs) (n = 20) in this study reported using tools they still favoured clinical judgement and 'interpretative' approaches. Nurses in other studies, also report some ambivalence towards using tools, viewing them as a technology of psychiatry designed to erode clinical expertise or as bureaucratic instruments without value or purpose (Raven & Rix 1999, Murphy 2004, Muir-Cochrane et al 2011, Gerace et al 2013. Conversely, others proposed that they facilitate discussion between practitioners about risk and enhance care documentation (Muir-Cochrane et al 2011).…”

Five‐year review of absconding in three acute psychiatric inpatient wards in Australia

“…Indeed, even when risk assessment measures are used in the clinical setting, absconding risk is often not included (Gerace et al . ). Reliable and valid data should drive any risk‐profile formulation and evidence‐based nursing interventions to reduce absconding (Fisher ; Mosel et al .…”

Critical Incidents During Leave From an Australian Security Hospital – A 12 Year Audit

“…Although nurses regularly make informal assessments, 40 formal assessment of the risk of absconding is often not done in clinical practice. 41 No research has generated a reliable "absconder profile" or risk assessment tool for absconding. 42 Even the period that a patient has been an inpatient does not necessarily predict absconding risk.…”