11VARIATION IN CAPACITY ASSESSMENT AND ADHERENCE TO THE MENTAL CAPACITY ACT AND DEPRIVATION OF LIBERTY SAFEGUARDS ACROSS A REGION: THE WESSEX EXPERIENCE

Abstract

Introduction: The Deprivation of Liberty Safeguards (DoLS) are an amendment to the Mental Capacity Act (MCA) 2005, and apply to patients who lack capacity to consent to care and treatment and are deprived of their liberty in hospital. Recent Supreme Court rulings have clarified the circumstances in which DoLS should be in place. We carried out an audit to review adherence to these rulings across all hospitals in our region. Method(s): 328 inpatients managed by geriatricians in 9 hospitals were randomly selected. Presence and type of cognitive impairment, any 4 stage capacity assessment and use of the MCA or DoLS were abstracted from the clinical notes. The clinical teams were asked whether they considered each patient had capacity to decide to remain in hospital. A standard data collection form was used in all hospitals and data was entered into a central system. The audit was registered in each trust and carried out over a one week period. Result(s): 188 inpatients (57%) under the care of geriatricians across the region had cognitive impairment, predominantly due to dementia (60%) or delirium (22%). For 67 of these patients (36%), there was evidence that a capacity assessment had been carried out. This proportion varied widely between trusts (10-73%). In 122 of these 188 patients (65%), the clinical team felt that the patient did not have capacity to decide to remain in hospital, yet there was evidence of the use of the MCA or DoLS in only 41 cases (39%). Again, there was wide regional variation (0-100%). Conclusion(s): Cognitive impairment is common in our hospital inpatients. Assessment and documentation of capacity to decide to remain in hospital occurred in a minority, as did use of the MCA or DoLS. There was substantial variation between hospitals, suggesting inter-hospital education and collaboration could improve the regional situation.