• Lynne Turner-Stokes, Karima Benaichouche-Motam, William Goodison, Adam Altaie, Alice Howard, Patrick McKnight, and Jessie Alfonso.
• Department of Palliative Care, Policy and Rehabilitation, Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK; Regional Hyper-acute Rehabilitation Unit, London North-West University Hospitals Trust, UK. Electronic address: lynne.turner-stokes@nhs.net.
• Clin Med (Lond). 2024 Sep 1; 24 (5): 100236100236.

AbstractFor patients who may lack capacity, the Mental Capacity Act 2005 requires capacity to be assessed for each decision at the time that treatment is offered, but this is not practical for every element of basic care and intervention delivered to patients undergoing rehabilitation following acquired brain injury, especially if their needs are changing. In this quality improvement project, we introduced a system for screening Mental Capacity and documentation to identify patients with a) largely intact cognition for whom capacity may be reasonably be presumed, and b) those in prolonged disorders of consciousness who clearly lacked capacity for all decisions. This enabled the multidisciplinary team to concentrate on evaluation of capacity in the third group who had more nuanced ability and required detailed assessment or support for decision-making. Two rounds of audit demonstrated that implementation improved the consistency of assessment and documentation. Multicentre roll-out of this approach is now required.Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.

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