The Kennedy Axis V is a routine outcome measurement instrument which can assist the
assessment of the short-term risk for violence and other adverse patient outcomes. The purpose of this
study was to evaluate the interrater reliability and clinical utility of the instrument when used by
mental health nurses in daily care of patients with mental illness. This cross-sectional study was
conducted in inpatient and outpatient adult psychiatric care units and in one adolescent inpatient unit
at a university hospital in the Netherlands. Interrater reliability was measured based on the independent
scores of two different nurses for the same patients. The clinical utility of the instrument
was evaluated by means of a clinical utility questionnaire. To gain a deeper understanding of rating
difficulties at the adolescent unit, additional data were collected in two focus group interviews. The
overall results revealed a substantial level of agreement between nurses (intraclass correlation coefficient
and Pearson 0.79). Some rating challenges were identified, including difficulties with scoring the
instrument and using tailor-made interventions related to the scores. These challenges can be resolved
using refined training and implementation strategies. When the Kennedy Axis V is accompanied by a
solid implementation strategy in adult mental health care, the instrument can be used for short-term
risk assessment and thereby contribute in efforts to reduce violence, suicide, self-harm, severe selfneglect, and enhanced objectivity in clinical decision-making.