Abstract
Background
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.
Aim
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.
Method
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.
Result
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.
Conclusions
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.
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Notes
In Australia, clinical coders use the coding classification system ICD-10-AM (Australian Modification) to identify and translate the narrative descriptions of diseases, injuries, and procedures contained in medical records into alphanumeric codes, based on Australian classification standards and conventions (Australian Consortium for Classification Development 2015). Although the position is not occupied by health professionals, clinical coding is a specialized skill requiring knowledge of medical terminology, disease processes, medical procedures, attention to detail, and analytical skills. As such, clinical coders receive specialized training by health authorities.
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Lamont, S., Stewart, C. & Chiarella, M. Documentation of Capacity Assessment and Subsequent Consent in Patients Identified With Delirium. Bioethical Inquiry 13, 547–555 (2016). https://doi.org/10.1007/s11673-016-9741-1
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DOI: https://doi.org/10.1007/s11673-016-9741-1