Care zoning in a psychiatric intensive care unit: strengthening ongoing clinical risk assessment

Authors

  • Antony Mullen MN, FACMH, MHN,

    Clinical Nurse Consultant and Conjoint Lecturer, Corresponding author
    1. Lake Macquarie Mental Health Service, Hunter New England Local Health District, Newcastle, Australia
    2. School of Nursing & Midwifery, University of Newcastle, Newcastle, Australia
    • Correspondence: Antony Mullen, Clinical Nurse Consultant, Conjoint Lecturer, Lake Macquarie Mental Health Service, Hunter New England Local Health District and School of Nursing & Midwifery, Po Box 833, Newcastle 2300, NSW, Australia. Telephone: +02 4033 5031.

      E-mail: antony.mullen@hnehealth.nsw.gov.au

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  • Vincent Drinkwater RN, BHA, MACMHN,

    Nurse Unit Manager
    1. Psychiatric Emergencies Services, Hunter New England Local Health District, Newcastle, Australia
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  • Terry J Lewin BCom

    Research Manager, Conjoint Associate Professor
    1. Mental Health Service, Hunter New England Local Health District, Newcastle, Australia
    2. School of Medicine and Public Health, and Centre for Translational Neuroscience and Mental Health (CTNMH), University of Newcastle, Newcastle, NSW, Australia
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Abstract

Aims and objectives

To implement and evaluate the care zoning model in an eight-bed psychiatric intensive care unit and, specifically, to examine the model's ability to improve the documentation and communication of clinical risk assessment and management.

Background

Care zoning guides nurses in assessing clinical risk and planning care within a mental health context. Concerns about the varying quality of clinical risk assessment prompted a trial of the care zoning model in a psychiatric intensive care unit within a regional mental health facility. The care zoning model assigns patients to one of 3 ‘zones’ according to their clinical risk, encouraging nurses to document and implement targeted interventions required to manage those risks.

Design

An implementation trial framework was used for this research to refine, implement and evaluate the impact of the model on nurses' clinical practice within the psychiatric intensive care unit, predominantly as a quality improvement initiative.

Methods

The model was trialled for three months using a pre- and postimplementation staff survey, a pretrial file audit and a weekly file audit. Informal staff feedback was also sought via surveys and regular staff meetings.

Results

This trial demonstrated improvement in the quality of mental state documentation, and clinical risk information was identified more accurately. There was limited improvement in the quality of care planning and the documentation of clinical interventions. Nurses' initial concerns over the introduction of the model shifted into overall acceptance and recognition of the benefits.

Conclusions

The results of this trial demonstrate that the care zoning model was able to improve the consistency and quality of risk assessment information documented. Care planning and evaluation of associated outcomes showed less improvement.

Relevance to clinical practice

Care zoning remains a highly applicable model for the psychiatric intensive care unit environment and is a useful tool in guiding nurses to carry out routine patient risk assessments.

Ancillary