Documentation of Capacity Assessment and Subsequent Consent in Patients Identified With Delirium
Delirium is highly prevalent in the general hospital patient population, characterized by acute onset, fluctuating levels of consciousness, and global impairment of cognitive functioning. Mental capacity, its assessment and subsequent consent are therefore prominent within this cohort, yet under-explored.
This study of patients with delirium sought to determine the processes by which consent to medical treatment was attempted, how capacity was assessed, and any subsequent actions thereafter.
A retrospective documentation review of patients identified as having a delirium for the twelve months February 2013 to January 2014 was undertaken. Inclusion and exclusion criteria were used; demographic and descriptive data collected. A total of n=1153 patients were identified with n=310 meeting inclusion criteria.
A random sample of one hundred patients were subsequently reviewed. One third of patients (n=33) had documentation relating to consent, while four patients had documentation relating to capacity. Median delirium duration was three days, with treatment refusal occurring in twenty-two patients and “duty of care” being used as an apparent beneficent related treatment framework in twelve patients.
While impaired decision-making was indicated, the review was unable to indicate what patient characteristics flag the need for capacity assessment. Documentation relating to consent processes (whether patient or substitute) appeared deficient for this cohort.
Key wordsMental capacity Informed consent Capacity legislation Guardianship Substitute consent Duty of care Treatment objection Delirium
- American Psychiatric Association: American Psychiatric Association DSM Task Force. 2013. Diagnostic and statistical manual of mental disorders: DSM-5 2013.Google Scholar
- Australian Consortium for Classification Development. 2015. The ninth edition of ICD-10-AM/ACHI/ACS. https://www.accd.net.au/Icd10.aspx.
- Australian Institute of Health and Welfare. 2015. http://www.aihw.gov.au/hospitals-data/ar-drg-data-cubes/. Accessed October 29, 2015.
- Blake, M. 2008. Religious beliefs and medical treatment. Bond Law Review 19: i.Google Scholar
- Holmboe, E.S. , ed. 2008. Practice audit, medical record review, and chart-stimulated recall. In Practical guide to the evaluation of clinical competence, edited by E.S. Holmboe. and R.E. Hawkins, 60–75. Philadelphia, USA: Mosby Elsevier.Google Scholar
- Kerridge, I., M. Lowe, and C. Stewart. 2013. Ethics and law for the health professions, 4th ed. Sydney: Federation Press.Google Scholar
- ——— 2013b. Health care professionals’ knowledge, attitudes and behaviours relating to patient capacity to consent to treatment: An integrative review. Nursing Ethics 20(6): 684–707.Google Scholar
- Mattar, I., M.F. Chan, and C. Childs. 2013. Risk factors for acute delirium in critically ill adult patients: A systematic review. ISRN Critical Care 2013: 10.Google Scholar
- New South Wales Health Department. 2005. Consent to medical treatment—Patient information 2005. http://www.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_406.pdf. Accessed January 12, 2011.
- Staunton, P., and M. Chiarella. 2013. Nursing and the law, 7th ed. Sydney: Churchill Livingstone.Google Scholar
- Stewart, C., I.H. Kerridge, and M. Parker. 2008. The Australian Medico-Legal Handbook. Sydney: Elsevier.Google Scholar
- Zaubler, T., J.R. Fann, S. Roth-Roemer, W.J. Katon, R. Bustami, and K.L. Syrjala. 2010. Impact of delirium on decision-making capacity after hematopoietic stem-cell transplantation. Psychosomatics 51(4): 320–329.Google Scholar