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.