Abstract
Introduction
The Mental Capacity Act is designed to protect patients who may lack the mental capacity to make decisions about treatment. At the Nuffield Orthopedic Centre (NOC) in Oxford, nurses obtain a baseline AMTS during the pre-operative assessment clinic. Following on from this, any patient over 64 years old that is seen by the orthogeriatrics team will have a post-op AMTS done to assess for cognitive impairment. If the AMTS is less than 8, or the patient is clinically believed to be delirious, then an MCA form will be completed for the decision to accept treatment. The aim of this QI project was to widen this practice to all the junior doctors at the NOC.
Method
AMTS and MCA data were collected from one month of inpatients >64 years old at the NOC. The AMTS were analysed and the patients with post-op AMTS of <8 were identified and checked for MCA form completions. The data was presented to junior doctors at the NOC, and a repeat cycle was performed to assess if the practice was being implemented.
Results
Data collected from 10/01/23 – 10/02/23 (n=125) showed that out of 10 patients meeting the AMTS criteria, only 4 had MCA forms completed. Once the QI projected was presented on 25/05/23, data collected from 12/06/23 – 15/07/23 showed that out of 5 eligible patients, 4 of them had MCA forms completed.
Conclusion
Prior to this QI project, only 40% of eligible patients from the collected data were having MCA forms completed by junior doctors at the NOC. Following the presentation to raise awareness, the data collected shows that this figure had increased to 80%. In conclusion, this QI project has been a success and should be repeated every 4 months to account for each new rotation of junior doctors.