Improving recording of capacity to consent and explanation of medication side effects in a psychiatric service for people with learning disability: Audit findings

Abstract

This study aimed to examine the practice of psychiatrists in a large learning disability service in recording capacity to consent to treatment and side effect discussion, and the impact of measures aimed at improving this. Three audit cycles were completed between 2007 and 2009, each examining 26 case notes selected at random. Information was gathered on recording of capacity and documentation of explanation of potential side effects. Changes in practice following the introduction of a rubber stamp in 2008, as a visual prompt for clinicians, were examined. Rates of recording of capacity rose from 30% in 2007 to 51% in 2009 (P = 0.000006). Capacity was more likely to have been recorded if the stamp was present (odds ratio 13.5, p < 0.0001). Recording of side effect discussion was consistently higher than that of capacity and showed little change between cycles. We conclude that the use of a rubber stamp in case notes was associated with improvements in the recording of capacity assessments.

Respeto a los derechos de las personas que se atienden en Servicios de Psiquiatría Ambulatoria en Chile

“…Se debe tener en cuenta, sin embargo, que generalmente el nivel de respeto de derechos de usuarios es menor en servicios psiquiátricos de hospitalización que en los ambulatorios 12,22 . En países de Europa Occidental se han realizado varios estudios de servicios ambulatorios de Psiquiatría y de otras especialidades, utilizando métodos diferentes al QualityRights, en los que se han medido el respeto de algunos de los derechos evaluados en nuestra investigación, tales como consentimiento informado, trato adecuado a los usuarios, consideración de las preferencias de los usuarios, apoyo para la inclusión social, acceso a la ficha clínica y confidencialidad [22][23][24][25][26][27][28][29] . En estos estudios se aprecia que los procedimientos desarrollados y el nivel de resguardo y ejercicio de derechos son superiores a los resultados encontrados en los servicios de Psiquiatría Ambulatoria chilenos.…”

Best interests decisions: professional practices in health and social care

“…Since the MCA came into force in 2007, research has often highlighted inconsistencies in practice (Lepping , Roy et al . ). Furthermore, the specific roles introduced by the MCA, such as the independent mental capacity advocate (IMCA), have perhaps been patchily understood and deployed in best interests decisions (Redley et al .…”

Poor adherence to the mental capacity act and premature death

“…Research within the past three years has suggested that improvements were needed with regard to the implementation of the MCA particularly within health (Phair and Manthorpe, 2012;Rowley et al, 2013;Sleeman and Saunders, 2013;McVey, 2013) and social care (Dunn et al, 2010;Boyle, 2011;Willner et al, 2012) settings. In particular, research has suggested shortcomings in assessing capacity by health and social care staff (Willner et al, 2011;Waight and Oldreive, 2011;Skinner et al, 2011;Roy et al, 2011;Lepping, 2011;Williams et al, 2012) and poor documentation of assessments of capacity and the decision-making process (Sorinmade et al, 2011). Although more recent research has highlighted some evidence of changing practice within health and social care (Manthorpe et al, 2014), the House of Lords Select Committee undertaking post-legislative scrutiny of the MCA concluded that:…”