Updating Relatives of Patients Lacking Capacity in General Medicine: A Quality Improvement Project in a District Hospital in the United Kingdom

Background Patient-centred care involves focussing on the individual's needs. Where patients lack capacity, it is important to involve relatives to better understand their needs, encourage positive healthcare outcomes and provide good quality care. Cultivating good rapport between clinicians and families also improves patient safety and satisfaction. Aim This project aims to improve the process of updating relatives regularly within various medical departments in the hospital. The quality improvement (QI) also strongly advocates for a minimum of two updates within a week of admission, for patients who lack capacity and who are on Deprivation of Liberty Safeguards (DOLS). This framework can be extrapolated to different medical settings to ensure ongoing patient care is conveyed and discussed effectively with families at regular and frequent intervals. Methodology This was a retrospective study that involved a total of 121 patients who lacked capacity and who were admitted to the acute medical unit, cardio-respiratory wards and geriatric wards in a district hospital. The project was designed using Plan-Do-Study-Act (PDSA) cycles and conducted over four months. Data mainly focused on details of relative updates from the time of admission, which were extracted from electronic records. Two interventions were conducted, with data gathering done before and after each intervention to ensure completeness of each PDSA cycle and measure the efficacy of the intervention. The first and second audits involved 56 and 65 patients, respectively. Results Data were collected regarding the number of relatives being updated within the first 48 hours and first week of admission. Collected data also involved details of the staff involved in these updates and the content of the updates. Clinicians accounted for the larger proportion of the staff conducting relative updates for patients on DOLS. Five (36%) in the first audit and 8 (37%) in the second audit of acute medical wards saw doctors at various training levels and roles carrying out the relative updates. In Cardio-Pulmonary wards, these numbers were 50% (8) in Audit 1 and 44% (7) in Audit 2. The greatest clinician burden was observed in geriatric wards wherein 73% (19) in Audit 1 and 53% (15) in Audit 2 of relative update data showed clinicians performing these updates. Coming to the frequency, collated data show an overall positive trend across all the wards where relatives were updated within one week. A positive trend was noted, especially in the Geriatric and Cardio-Pulmonary wards, with improvement in the first week of updates going up, from 35% to 46% and 29% to 48%, respectively. Significant room for improvement in updating relatives within 48 hours of admission still exists. About 53% of the updates included information about the patient's condition. Details regarding follow-up were only noted in 41% of the updates. Conclusions This study highlights the need to ensure that the relatives of patients who lack capacity are updated more regularly. Colleagues are encouraged to use appropriate documentation methods such as relative progress notes to ensure ease of future updates. It is essential that relatives are updated not only on the patients' condition and diagnosis but also, whenever possible, on investigations, management, and follow-up. A minimum of two updates in the first week is highly advisable. Effective communication and regular updates improve discharge planning and patient outcomes.