The Deprivation of Liberty Safeguards (DoLS) are an important safeguarding measure for all patients. It has particular relevance in Elderly Medicine and, increasingly, the Palliative care setting. When patients lack capacity, the use of restrictions and restraints may be authorised, if, in a patient’s best interests. Their appropriateness and overlap with end of life care is a complex and ethically challenging area. This piece of legislation has led to an increased workload for healthcare professionals as the number of DoLS applications, and hence paperwork, has spiked in recent years. In an already resource stretched setting, this audit aims to:

1. Assess the current use of DoLS at UCLH including:

2. Clear documentation when patient lacks capacity to consent to staying in hospital.

3. Timely identification of potential deprivation of liberty and therefore DoLS applications.

4. Identify areas for quality improvement.

Method Patients’ capacity status was discussed with their consultant. The acid test was applied to determine if a DoLS applications was indicated. The medical notes were reviewed to see if this had been completed. Data was collected for 40 patients across two wards.

Results

• 45% of patients lacked capacity and met the acid test criteria meaning a DoLS application is indicated. Only 33% of these patients had evidence in the notes of a completed DoLS application.

• On review of the medical notes, capacity assessments were documented in 1/3 of cases.

• When a DoLS application was indicated, 50% of cases had a form sent on Ward 1 but 0% did on Ward 2.

ResultsOur findings show that more work is needed in this safeguarding domain. We recommend identifying ways to improve compliance with this piece of legislation to avoid potential unlawful practice. We will address three areas prior to re-auditing:

• Teaching.

• Increasing awareness of existing resources.

• Simplifying process of completing a DoLS application.