Policy Number LCH-45 This document has been reviewed in line with the Policy Alignment Process for Liverpool Community Health NHS Trust Services. It is a valid Mersey Care document, however due to organisational change this FRONT COVER has been added so the reader is aware of any changes to their role or to terminology which has now been superseded. When reading this document please take account of the changes highlighted in Part B and C of this form. Part A Information about this Document Policy Name Shared Decision Making Guidelines Policy Type Board Approved (Trust-wide) Trust-wide Divisional / Team / Locality Action No Change Minor Change Major Change New Policy No Longer Needed Approval As Mersey Care s Executive Director / Lead for this document, I confirm that this document: a) complies with the latest statutory / regulatory requirements, b) complies with the latest national guidance, c) has been updated to reflect the requirements of clinicians and officers, and d) has been updated to reflect any local contractual requirements Signature: Date: Part B Changes in Terminology (used with Minor Change, Major Changes & New Policy only) Terminology used in this Document New terminology when reading this Document Part C Additional Information Added (to be used with Major Changes only) Section / Paragraph No Outline of the information that has been added to this document especially where it may change what staff need to do Part D Rationale (to be used with New Policy & Policy No Longer Required only) Please explain why this new document needs to be adopted or why this document is no longer required Part E Oversight Arrangements (to be used with New Policy only) Accountable Director Recommending Committee Approving Committee Next Review Date LCH Policy Alignment Process Form 1
SUPPORTING STATEMENTS This document should be read in conjunction with the following statements: SAFEGUARDING IS EVERYBODY S BUSINESS All Mersey Care NHS Foundation Trust employees have a statutory duty to safeguard and promote the welfare of children and adults, including: being alert to the possibility of child / adult abuse and neglect through their observation of abuse, or by professional judgement made as a result of information gathered about the child / adult; knowing how to deal with a disclosure or allegation of child / adult abuse; undertaking training as appropriate for their role and keeping themselves updated; being aware of and following the local policies and procedures they need to follow if they have a child / adult concern; ensuring appropriate advice and support is accessed either from managers, Safeguarding Ambassadors or the trust s safeguarding team; participating in multi-agency working to safeguard the child or adult (if appropriate to your role); ensuring contemporaneous records are kept at all times and record keeping is in strict adherence to Mersey Care NHS Foundation Trust policy and procedures and professional guidelines. Roles, responsibilities and accountabilities, will differ depending on the post you hold within the organisation; ensuring that all staff and their managers discuss and record any safeguarding issues that arise at each supervision session EQUALITY AND HUMAN RIGHTS Mersey Care NHS Foundation Trust recognises that some sections of society experience prejudice and discrimination. The Equality Act 2010 specifically recognises the protected characteristics of age, disability, gender, race, religion or belief, sexual orientation and transgender. The Equality Act also requires regard to socio-economic factors including pregnancy /maternity and marriage/civil partnership. The trust is committed to equality of opportunity and anti-discriminatory practice both in the provision of services and in our role as a major employer. The trust believes that all people have the right to be treated with dignity and respect and is committed to the elimination of unfair and unlawful discriminatory practices. Mersey Care NHS Foundation Trust also is aware of its legal duties under the Human Rights Act 1998. Section 6 of the Human Rights Act requires all public authorities to uphold and promote Human Rights in everything they do. It is unlawful for a public authority to perform any act which contravenes the Human Rights Act. Mersey Care NHS Foundation Trust is committed to carrying out its functions and service delivery in line the with a Human Rights based approach and the FREDA principles of Fairness, Respect, Equality Dignity, and Autonomy Page 2 of 9
Shared Decision Making Guidelines Page 3 of 9
Version Control Version Number: 2 Reference 045 Ratified by: Clinical Standards Group Date of Approval: 21 st November 2017 Name of originator/author: Approving Body / Committee: Mental Capacity Act Co-Ordinator Safeguarding Adults Team Clinical Standards Group Date issued (Current version): November 2017 Review date (Current Version): November 2019 Target Audience: LCH Staff Name of Lead Director / Managing Director: Changes / Alterations Made To Previous Version: Director of Nursing No changes Page 4 of 9
Shared Decision Making Guidelines What is shared decision making? Shared decision making (SDM) is a process where a patient and their clinician are jointly engaged in the decision making process to choose a treatment, investigation or screening option which is consistent with the patient s individual needs, values and preferences. Patients are involved as active partners with professionals. Why is shared decision making important? Internationally, SDM is seen as a hallmark of good clinical practice. A review of patient participation in decision making concluded that patients wanted to be informed of treatment, treatment alternatives outcomes and risks. SDM can provide the opportunity for resolving any mismatch between clinician and patient expectations and is a way of enhancing patient engagement. No decision about me, without me. This can only be realised by involving patients fully in their own care, with decisions made in partnership with clinicians, rather than by clinicians alone. The process of shared decision making. As many patients are unfamiliar with being invited to share in decision making, it may help to briefly explain the process. Outlining that they have some choices you would like to go through with them before deciding together about the next step may reassure patients who might otherwise feel overwhelmed or uncertain. Mental Capacity Act Just because a patient has a mental impairment does not mean that those patients and their carers should not be involved in decisions about their care. Options may need to be communicated in different or more appropriate ways and patients need to be supported in understanding the options and their implications, as well as being assisted in making and communicating their choices. The principles of the Mental Capacity Act must be adhered to in any decision making where a patient lacks capacity or their capacity is predicted to deteriorate over time. The Mental Capacity Act requires that all practical and appropriate steps are taken to enable a person to make the decision themselves. If the person is deemed to lack capacity for the specific decision, then the practitioner must document this and a decision should be taken in the person s best interest. Children and Young People The principles of shared decision making should apply equally to all people regardless of age, and acknowledge that young people may require additional support to be fully involved in decisions about their care. Page 5 of 9
Shared Decision Flow Chart What is the decision to be made Assume capacity unless given reason to doubt and all assistance has been given. Capacity No capacity Patient wishes/goals discussed. LCH Mental Capacity Act documentation. Act in Best interest if lacking mental capacity. Practitioner gives full benefits, risks and optimum treatment plan in a way the patient understands best. Include relevant important people in decision making process. Consider any Advance Decisions or Lasting Power of Attorney. Best interest meeting. Patient choice at that moment YES NO Patient agrees to treatment. Patient declines optimum treatment plan. Personalise (compromise) plan developed with Page 6 of 9 patient
Shared Decision Tool Document. Decision: to reduce risk of harm associated with pressure ulcers/or condition Patient views/goals are - Patient declined to engage Full Information given to patient (full treatment options, risk, benefits and alternatives explained) Detail optimum treatment. - Patient decision /choice.what the patient wants or does not want. (Take into account patients views, previous experience and knowledge).document decision. i.e. Does not want airflow mattress because.. Does not want daily visits because Patient declined to engage Outcome- shared plan (Document any compromise to treatment plan ) Page 7 of 9
If unable to formulate a shared plan of care 1/ Escalate to manager. 2/ Complete Datix. 3/Agree review date with manager and patient. Review date is. All details of this plan have been explained and agreed with patient Patients signature..... Health Professional Date Any other information.. The record of the decision or the care plan should be accessible to patients as well as health professionals. Please keep a copy of this shared decision tool in the patients health record. The recorded outcome can be used for a number of purposes: As a record of the shared decision making process. To help to coordinate care when patients receive treatment or support from a range of professionals or agencies. As a personally held record that can be continually updated to support behaviour change if the patient decides to undertake a lifestyle or behaviour change. Page 8 of 9
Could provide protection from legal challenges if clinicians can demonstrate that patients were offered choices and provided with reliable information about the options. Reference Documents. Liverpool Community Health NHS Trust-Mental Capacity Act Policy- (Available on SIRS) Mental Capacity Act - Code of Practice (issued 2007) http://www.justice.gov.uk/guidance/mca-code-of-practice.htm Making Shared Decision Making a Reality - No decision about me, without me. Coulter and Collins, Kings Fund 2011 www.kingsfund.org.uk/publications Department of Health s Reference guide to consent for examination or treatment. https://www.gov.uk/government/organisations/department-ofhealth Page 9 of 9