Improving the legal compliance of DoLs applications in the geriatric setting

Deprivation of Liberties Safeguards (DoLS) are used across many areas of our hospital with 163 applications made within the past 10 months. When sampled the pre-intervention baseline compliance was 32.5.% for DoLS submissions with MCAs documented on electronic patient records (EPR).  These gaps risk unlawful deprivation of liberty and compromised patient safety. This QIP primarily aims to improve legal compliance of DoLS to 70% within ten months. 

Initial intervention was the creation of awareness posters as well as a DoLS champion who delivered teaching sessions to F1s explaining how to complete the DoLs framework. This doctor would also recruit the next DoLS champion to succeed them and continue to educate. After the second cycle we completed an additional intervention by embedding prompts to complete an MCA into the DoLS form instead of relying on memory alone. We are also in the process of developing an icon within EPR to improve visibility of active or soon expiring DoLS.

Our results showed significant increases in the percentage of DoLS applications meeting the legal criteria. The data collected suggests between the first and second cycle an increased compliance from 30% to 58.3% with a chi squared of χ^2 = 9.0667,  p<0.01 confidence interval. Between the second and the third cycle there was an increase in compliance from 58.3% to 81.5% with chi squared of χ^2 = 4.8670, p<0.05. This suggests a statistically significant improvement in the proportion of legal DoLS applications made.

This project improved care by achieving an MCA compliance rate of 81.5% surpassing our 70%  goal thus strengthening lawful decision making. Whilst our interventions proved successful, to achieve long term improvement requires systemic change to the way the DoLS are submitted within our trust. Reliable safe practice depends on embedding prompts into workflow rather than relying on individual knowledge and memory.