Patients in the acute phase of their illness frequently become restless and inadvertently remove feeding tubes and other essential access lines. This could be due to the patient having delirium or an acute confusional state secondary to their illness. At this stage they may lack capacity, or have fluctuating capacity to make decisions for themselves in relation to having a feeding tube or access line inserted. If they have a feeding tube or access line in place it is vital to remember that this can be distressing. However it will only have been inserted after discussion with the patient or their carers or relatives and patients lacking capacity, it would have been documented as part of a best interest plan.
A capacity assessment must be completed to assess the patient’s ability to understand the proposed treatment plan and implications if essential access is removed. If the patient has capacity, the patient should consent to the decision specific to the assessment. Additional capacity assessments may need to be completed for patients whose capacity is identified as fluctuating.
A best interest decision must be completed after the capacity assessment if the patient is found to lack capacity. Refer to the Mental Capacity Act policy for MCA assessment and best interest forms to support and document decision making.
The family and carers should be consulted in relation to the decision but are not the key decision makers unless they have a valid Lasting Power of Attorney (LPA). The complexity of the decision being made will influence who needs to be included in the process, and the mental capacity act policy should be used to support decision making processes as necessary. The use of mittens for patients lacking capacity must be identified as the least restrictive option for care management purposes within the best interest plan and the senior clinician (consultant) should support the care pathway being followed.
|Safeguarding Committee (Chair’s action)
- Mental Capacity Policy
- Adult Safeguarding Policy
- Deprivation of Liberty Policy
- Enteral Feeding Policy
- Vascular Access Policy
- Restraint Policy