1 Introduction
The purpose of this policy is to provide guidance on assessing and documenting a patient\\\’s capacity to consent to medical assessment and treatment. It ensures compliance with relevant UK legislation, including the Mental Capacity Act 2005, Mental Health Act 1983, and Care Quality Commission (CQC) regulations. The policy outlines the principles of consent, capacity assessment, and the management of patients who refuse treatment or have a Do Not Attempt Resuscitation (DNAR) order.
2 Scope
This policy applies to all healthcare professionals (HCPs) employed or contracted by Coast Medic Ambulance Ltd., including paramedics, emergency medical technicians, and other staff involved in patient care.
3 Legal Framework and Standards
Mental Capacity Act 2005: Provides a statutory framework for assessing and making decisions on behalf of individuals who lack capacity.
Mental Health Act 1983: Governs the admission and treatment of patients with mental health conditions.
Human Rights Act 1998: Ensures the protection of patient rights, including the right to private life and bodily integrity.
Care Quality Commission (CQC) Regulations: Regulate and monitor the quality and safety of care provided by healthcare services.
4 Principles of Consent and Capacity
Voluntariness: Consent must be given voluntarily, without coercion.
Informed Consent: Patients must be provided with all necessary information to make an informed decision about their care.
Capacity: The ability to understand, retain, weigh information relevant to a decision, and communicate that decision.
5 Assessment of Capacity
5.1 When to Assess Capacity
Capacity should be assessed:
Prior to any assessment, treatment, or intervention.
When there is any doubt about the patient’s ability to consent.
When a patient’s condition or circumstances suggest they may lack capacity.
5.2 The Two-Stage Test
Diagnostic Test: Determine if there is an impairment of, or disturbance in, the functioning of the mind or brain.
Functional Test: Assess if the impairment prevents the person from:
- Understanding the information relevant to the decision.
- Retaining that information.
- Using or weighing that information as part of the decision-making process.
- Communicating their decision.
6 Documenting Consent and Capacity
All assessments of capacity and consent decisions must be documented in the patient’s clinical record.
Record the following:
- Information provided to the patient.
- Patient\\\’s understanding and decision-making process.
- The outcome of the capacity assessment.
- The patient\\\’s decision and any subsequent actions taken.
7 Managing Patients with Impaired Capacity
7.1 Best Interests
When a patient is found to lack capacity, any decision or action taken must be in their best interests. Consider:
- The patient\\\’s past and present wishes and feelings.
- The beliefs and values that would likely influence their decision if they had capacity.
- The views of family members, carers, or anyone with a close relationship to the patient.
7.2 DNAR Orders
DNAR orders must be respected and followed, provided they are valid and applicable.
HCPs should verify the presence of a DNAR order, and if any doubt exists, initiate appropriate emergency care while seeking clarification.
Document any DNAR orders in the patient’s clinical record, including verification details and actions taken.
7.3 Refusal of Interventions
Patients with capacity have the right to refuse treatment, even if it may result in harm or death.
Ensure the patient understands the consequences of refusing treatment. Document the refusal, including the information provided to the patient and their understanding of the potential outcomes.
7.4 Advance Decisions and Lasting Power of Attorney
- Recognize and respect valid advance decisions and Lasting Power of Attorney (LPA) for health and welfare decisions.
- Verify the validity and applicability of any advance decision or LPA and document the verification process and subsequent actions.
8 Emergency Situations
In emergencies, where obtaining consent is not possible and immediate treatment is necessary to save life or prevent serious deterioration, HCPs may proceed with treatment in the patient\\\’s best interests. Document the emergency nature of the situation and the rationale for proceeding without consent.
9 Training and Competency
All staff must receive training on consent and capacity, including the relevant legislation and ethical considerations. Staff must demonstrate competency in assessing capacity and documenting consent as part of their professional responsibilities.
10 Monitoring and Review
This policy will be monitored through regular audits of clinical records and staff feedback. The policy will be reviewed annually or in response to changes in legislation, clinical guidelines, or organizational needs.