A Roadmap for Assisted Decision-Making Capacity Assessment: Developing a Guide for Occupational Therapists in an Acute Setting

Abstract

Abstract Background The Assisted Decision-Making (Capacity) Act (ADMA) has been in effect since April 2023. Under the ADMA, Occupational Therapists (OTs) are a prescribed class of healthcare professionals capable of assessing a person's decision-making capacity (DMC). OTs must adapt their practice to comply with the new legislation. OTs in an acute hospital reported poor understanding and low confidence using the ADMA. The aims were to enhance OTs knowledge and understanding of the ADMA, how to adapt their practice and to improve OTs documentation of DMC assessment in healthcare records. Methods OTs were surveyed to ascertain their current understanding of the ADMA, confidence using its guiding principles and to identify specific learning needs to address in education sessions. A multi-modal approach including tailored in-service education and 1:1 coaching sessions enhanced OTs knowledge and confidence in using the ADMA. Template documents were developed to guide OTs documentation of DMC assessment in healthcare records. A post-education survey was administered to determine if education sessions and guidance documents had benefitted OTs. Results Knowledge in using the ADMA improved post-education. 67% reported their understanding as ‘good’ compared to 14% pre-education. 0% reported knowledge as 'poor' or 'very poor' post-education compared to 24%. Confidence improved with 8% reporting they feel ‘very comfortable’ assessing DMC post-education compared with 0%. 0% reported 'not at all comfortable' post-education compared to 18%. 100% of OTs who availed of 1:1 coaching reported benefitting from mentoring. 100% of OTs reported guidance documents benefit their practice. 85% reported the education met their expectations. Conclusion OTs are continuing to learn how to use the ADMA in their practice. OTs require ongoing education and training to improve their skills in DMC assessment and documentation of this process. Changing practice in accordance with the ADMA may take time as this change needs to occur at a national and local level.