# Improving the Completion of Mental Capacity Act (MCA) Assessments and Deprivation of Liberty Safeguards (DoLS) in Complex Medical Units at the John Radcliffe Hospital

## TL;DR

This audit assesses how well mental capacity assessments and DoLS are used in hospital units for older patients with cognitive issues.

## Contribution

The study identifies gaps in MCA and DoLS completion and evaluates the impact of educational interventions in hospital units.

## Key findings

- Only 27.4% of eligible patients had a mental capacity assessment in the first audit cycle.
- Educational interventions led to a slight increase in AMTS assessments but not in DoLS completion rates.
- Further multidisciplinary education is needed to improve compliance with MCA and DoLS protocols.

## Abstract

Objective

Cognitive disorders can impair decision-making ability in older adults. In patients with cognitive disorders, including cognitive impairment, dementia and delirium, a mental capacity assessment (MCA) should be undertaken to assess whether a patient can consent to inpatient treatment. If a patient is found not to have capacity, a Deprivation of Liberty Safeguards (DoLS) should be authorised. This audit evaluates whether MCA and DoLS are used appropriately across the four Complex Medical Units (CMUs), which treat multimorbid patients, at the John Radcliffe Hospital.

Methods

The first and second rounds of assessment were completed on September 26, 2022 (n=65) and December 13, 2022 (n=66), respectively. Inpatients in CMUs aged ≥70 years were assessed for records of Abbreviated Mental Test Score (AMTS) <8, or diagnosis of delirium or cognitive impairment, which may indicate a lack of capacity to consent to inpatient admission. Where these criteria were met, it was assessed whether patients had a mental capacity assessment regarding hospital admission and a DoLS application if found to lack capacity.

Results

Patient characteristics were similar across the two cycles. In the first cycle, 66.2% (n=43) had AMTS assessment completed. Of the 62 eligible patients, 27.4% had a mental capacity assessment and 17.7% had DoLS in place. Interventions included MCA-DoLS teaching to CMU doctors and a week-long pilot measure in CMU-B to discuss MCA-DoLS during daily board rounds. In the second cycle, 72.7% (n=48) had AMTS assessment completed. Of the 58 eligible patients, 25.9% had a mental capacity assessment and 12.1% had DoLS in place.

Conclusion

MCA and DoLS protect patient’s rights while delivering quality care. Our audit has identified gaps in the current practice. Though educating doctors is effective, further work, including educating the multidisciplinary team, could help achieve higher rates of MCA-DoLS completion.