title: Documentation of Capacity Assessment and Subsequent Consent in Patients Identified With Delirium.
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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
authors.affiliation: Prince of Wales Hospital, Level 1 East Wing, Edmund Blackett Building, Sydney, NSW, 2031, Australia. Scott.Lamont@sesiahs.health.nsw.gov.au.
authors.forename: Scott
authors.initials: S
authors.lastname: Lamont
authors.affiliation: Sydney Law School, The University of Sydney, Sydney, NSW, 2006, Australia.
authors.forename: Cameron
authors.initials: C
authors.lastname: Stewart
authors.affiliation: Sydney Nursing School, The University of Sydney, Sydney, NSW, 2006, Australia.
authors.forename: Mary
authors.initials: M
authors.lastname: Chiarella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D003657:Decision Making; D003693:Delirium / Q000150:complications / Q000523:psychology; D004282:Documentation; D004992:Ethics, Medical; D005260:Female; D006760:Hospitalization; D006801:Humans; D007258:Informed Consent / Q000523:psychology*; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D016312:Treatment Refusal
keywords: Capacity legislation; Delirium; Duty of care; Guardianship; Informed consent; Mental capacity; Substitute consent; Treatment objection