title: Care zoning. A 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.
authors.affiliation: Northern Sydney Central Coast Mental Health and Drug and Alcohol Service, New South Wales, Australia. ktaylor@nsccahs.health.nsw.gov.au
authors.forename: Kris
authors.initials: K
authors.lastname: Taylor
authors.forename: Stuart
authors.initials: S
authors.lastname: Guy
authors.forename: Linda
authors.initials: L
authors.lastname: Stewart
authors.forename: Mark
authors.initials: M
authors.lastname: Ayling
authors.forename: Graham
authors.initials: G
authors.lastname: Miller
authors.forename: Anne
authors.initials: A
authors.lastname: Anthony
authors.forename: Anne
authors.initials: A
authors.lastname: Bajuk
authors.forename: Jo Le
authors.initials: JL
authors.lastname: Brun
authors.forename: Dianne
authors.initials: D
authors.lastname: Shearer
authors.forename: Rebecca
authors.initials: R
authors.lastname: Gregory
authors.forename: Matthew
authors.initials: M
authors.lastname: Thomas
mesh_terms: D006301:Health Services Needs and Demand; D006760:Hospitalization; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration*; D017064:Process Assessment, Health Care; D018570:Risk Assessment