Liverpool Heart and Chest Hospital

Transcription

1 Liverpool Heart and Chest Hospital Mental capacity and consent to treatment in patients with vascular dementia: a comparison of capacity assessments made in an acute setting vs. those made in the patients home

2 In my role as Lead Nurse I am often asked to support patients with vascular dementia who require major surgery to make a best interests decision around care and treatment choices. I found that assessing capacity in a clinic setting often felt rushed, and that not enough time was given to fully support the decision making process. Some patients would become agitated and confused simply by being in a new environment and meeting new people. Families would frequently say they re not like this at home. So we decided to undertake a small study using quality improvement methodology to see if there was an appreciable difference in patient responses when the capacity assessment took place in their own home rather than in the clinic.

3 Background Aims Concerns in tertiary care regarding treatment consent and best interests decisions are increasing as the UK population ages. Previous studies have concentrated on defining mental capacity, consenting to research and discharge strategies. Last year, Liverpool Heart and Chest Hospital piloted a method of capacity assessment in patients homes rather than in the potentially confusing and disorientating hospital environment. We aimed to find out whether patients were more likely to demonstrate that they had the mental capacity to consent to major surgery when assessments were conducted in their home environment rather than at the hospital. We further aimed to deliver more patient centred care through learning about unique home-life situations and having more effective communication with families.

4 Methods When dementia patients presented at clinic, their families often expressed concern that they were acting out of character, or were negatively affected by the unfamiliar environment and the unfamiliar people. With this in mind, we selected a small cohort of ten patients diagnosed with dementia. We assessed capacity to consent to treatment in clinic as usual and then did a follow up visit to the patients home a few weeks later. During this visit we also assessed the patients home environment, patient mobility and daily routines. Often their families were present at the home assessment, so were able to be more involved in preparing the patient for their hospital visit.

5 Results Six of the ten patients (60%) whom initially had been assessed as lacking capacity in the clinic were duly able to demonstrate that they did have capacity when assessed in their own homes. We were able to develop more personalised care plans and develop improved communication with family members regarding what the patient could expect during their hospital visit. An understanding of common problems encountered when assessing a dementia patient s capacity to consent to treatment A method to potentially improve the quality of patient care, with regards to mental capacity and consent to surgical treatment A method to potentially improve the quality of family involvement with dementia patient care

6 Next steps The dementia home assessment program was effective in delivering better information about hospital procedures and practices to the patients involved in the pilot study. Patients were calmer, more comfortable and more receptive to the information that was provided. Patients were also able to give a higher level of informed consent to treatment. Families felt more involved in the treatment strategy and better prepared for the hospital stay. This pilot study was conducted on 10 patients only, by a single nurse and from a single hospital. Further studies are required, using greater patient numbers and a wider variety of healthcare disciplines, before the positive benefits we have seen locally can be confirmed.