84 Mental capacity assessment audit

<h3>Background</h3> The Mental Capacity Act requires staff to consider a patient’s ability to make major decisions, including decisions about their property and affairs, health care treatments, where a person lives, and everyday decisions about personal care (where it impacts on their health and safety). To gain a better understanding of the quality of the mental capacity assessment (MCA) process, including who was involved, the questions asked and the reasons for the conclusions of the assessment we audited the processes, documentation, and outcomes related to how these assessments are carried out within our hospice. <h3>Methods</h3> We audited 30 cases to check that the MCA assessments and Best Interest Decision (BID) templates were accurate, documented properly, and upheld the rights and interests of individuals being assessed. <h3>Results</h3> The MCAs were completed by a range of health care professionals (HCPs), 12 doctors, 9 staff nurses, 5 Clinical Nurse Specialists, and 4 other HCPs. Capacity was assumed in 87% of MCAs; the nature of the cognitive impairment was documented in 81%; and considerations of whether the MCA could be delayed in 70%. Cultural and ethical beliefs were only documented to be considered in 1 case, and information from family members/carers was gathered in 36% of assessments. The BID template was completed appropriately in 75% of cases. <h3>Conclusions</h3> This audit highlighted areas we are doing well, and those that could be improved. The MCA and BID templates have been amended to gather evidence through diagnostic tests, functional tests, and observational data. A Support Toolkit has been introduced to help HCPs, along with development of training on strategies to engage families effectively and on the assessment of executive functioning.