Background In-patients receiving palliative care may lack capacity to make decisions regarding their medical treatment for many reasons e.g. delirium, dementia. If it is felt that a person cannot consent to treatment an Adults with Incapacity (AWI) Act (Scotland) Section 47 certificate can be completed, allowing healthcare staff to provide treatment while enshrining a number of safeguards for the patient. In 2016 NHS Grampian introduced new AWI Section 47 documentation and its use was audited in an acute palliative care unit.
Methods Data was collected from all in-patients in an acute palliative care unit over a 1 week period. Information was collected on four domains:
was an AWI certificate present in the medical notes,
was the decision to complete an AWI certificate documented in the medical notes (including the reasons for this decision),
was the AWI certificate completed correctly,
was there documentation of a discussion with Welfare Power of Attorney or next of kin regarding the decision to complete an AWI certificate.
Results Data was collected on 16 in-patients, 8 male and 8 female, mean age 71 years.
31% had an AWI certificate completed.
AWI certificate completed correctly in all cases.
1 patient had documentation of an assessment of capacity/completion of AWI certificate recorded in medical notes.
2 patients had documentation of discussion with Welfare Power of Attorney/next of kin.
Conclusions The proportion of patients with an AWI Section 47 certificate is in keeping with the prevalence of delirium in medical wards. There was good compliance with completion of the new AWI Section 47 certificates. Documentation of assessment of capacity/decision making and discussion with relevant others was lacking - these are important principles of the act and further education and training should address these areas.
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