Evidence Based Approach to Capacity Assessment for Hospitalized Patients

Abstract

Medical decision-making capacity (MDMC) is inherent to the legal and ethical principles of respect for autonomy and is an essential element of informed consent. Qualitative and quantitative evidence to support a final decision of capacity should be the gold standard. General hospital policies and state laws mandate that a licensed provider make the final determination of capacity, but they do not specifically mandate who is responsible for those assessments. When a patient s decisional capacity fluctuates, the role of the nurse in a hospital setting is valuable because they have the most direct contact with the patient. Objective: Determine receptiveness of nursing staff to assessing capacity, to gather feedback on the Aid to Capacity Evaluation (ACE) tool, and to ascertain awareness of capacity by sixty nurses working on progressive care, trauma orthopedic, and medical/surgical units. Method: This project was completed at a Midwestern academic level I trauma center. Nurses on a medical/surgical, orthopedic trauma, and progressive care unit participated. Education about MDMC and the ACE tool were given to nurses verbally and in writing. They were asked to utilize the Aide to Capacity Evaluation (ACE) tool to assess patients whom they believed lacked decision-making capacity. After four weeks the nurses completed an evaluation. Results: Thirty nurses (50%) responded. Over 70% of those respondents used the tool at least once. 63% agreed that the format helped to systematically evaluate a patient and they found it easy to incorporate into practice. Overall, 73% of respondents would welcome more education about capacity. Conclusion: Given a standardized tool in conjunction with proper and continuous education, bedside nurses are in an optimal position to identify mental changes early, alert the provider so steps can be taken to optimize mental capacity, and assist with assessment of capacity with minimal disruption of care. Implementation of a tool such as the ACE can ensure accurate, reliable, and consistent assessments. Furthermore, providers would benefit from the extra time to gather information and complete focused assessments to make a determination of capacity with confidence.