How one hospital is preparing for supported decision-making.

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  • The Assisted Decision Making Capacity Act (ADMCA) 2015 provides that each person should be supported to make decisions for themselves.
  • The South Infirmary Victoria University Hospital (SIVUH) undertook a survey of staff to see how equipped staff were to support people with an intellectual disability in hospital. The overall objective was to improve the quality of health care support provided to people with intellectual disability.
  • In summary staff felt that people with an intellectual disability received very good care in the hospital but that there was a training gap identified in terms of staff knowledge.

building 1In Ireland, with the introduction of the Assisted Decision Making Capacity Act (ADMCA) 2015, there is a move to supported decision making to restore autonomy and respect the human dignity of each person. The guiding principle is that a person should be supported to make decisions for themselves (Donnelly 2016). Under the UN Convention on the Rights of Persons with Disabilities (CRPD), there has been a move away from the use of the ICD-10 classification of disability to the language of “those who require intensive support”, which focuses more on supports needed rather than the diagnosis of intellectual disability (Stefansdottir et al 2018).

In order to prepare for the implementation of both the ADMCA and the CRPD, the South Infirmary Victoria University Hospital (SIVUH) undertook a survey of staff to see what training staff may have received and how equipped they were to support people with an intellectual disability while in hospital. The overall objective was to improve the quality of health care support provided to people with intellectual disability.

building2The questionnaire used was a validated audit tool from the Royal College of Psychiatrists in the UK which had been used as part of a national review of staff knowledge in the UK in 2014 (RCPUK 2014). The questionnaire focussed on knowledge of disability, staff views on support for this patient group, and their perception of the quality of healthcare support provided to people with intellectual disability. Five-point Likert scales were used to determine staff satisfaction and agreement with statements about meeting the healthcare needs of people with intellectual disabilities, training received, and support from the wider hospital. Staff could also provide free-text comments.

The survey was distributed to each ward and clinical area in paper format, and there were 135 respondents across all staff categories to include doctors, nurses, allied health professionals and support staff, which represented 13% of the total workforce. Doctors were 8% of the staff surveyed.  In total there were five questions examined in the survey:

  1. How well do you think this service meets the needs of people with intellectual disability?

66% of staff said that they had the ability to be flexible around allocating extra time for patients with an intellectual disability, for example more time at ward rounds or for appointments in outpatients.

  1. Professional knowledge

In the context of the Assisted Decision Making Capacity Act (ADMCA), 51% of staff said that their training would not enable them to understand the ADMCA and how this would include the involvement of patients with an intellectual disability in decisions about their care.

  1. Have you received training around intellectual disability?

81% of staff across all disciplines stated that they had not received specialist training around intellectual disability in the last year, with a further 9% of staff saying they had received training but it was over one year ago.

  1. Would further staff training help to deliver better support to people with an intellectual disability?

91% of staff agreed that further training would help them to better support people with an intellectual disability.

  1. Support

70% of staff were not aware of how to contact specialist staff in intellectual disability, like for example a community specialist nurse in intellectual disability or a liaison nurse.

In summary staff felt that people with an intellectual disability received very good care in the hospital but that there was a clear training gap identified in terms of staff knowledge. Staff were also very committed to improving the supports that could be provided to people with an intellectual disability while in hospital.

The next steps for the hospital include arranging training on disability awareness for staff, to include how a person can be supported to make a healthcare decision for themselves. It is also planned to link in with disability service providers in the Southern region, so that the SIVUH would have advance notice of people coming from residential care settings to the hospital, and can identify what supports each person requires when they come into the hospital.

Kieran Murphy is Quality and Risk Manager at the South Infirmary-Victoria University Hospital, Cork. Further contributions came from Brenda O’Brien (Nurse Practice Development Coordinator), David Murphy, Briain Madden and Eileen Geaney of the Quality Department, Dr. Eoin Roche and Dr. Ian McBride.

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