1. Implementation and Expansion of a Model for Assessment of Capacity at Caritas (MCH, GNH) INTRODUCTION Assessment of capacity deals with the ethical dilemma of removing a human being's decisional sovereignty. Feedback from administrative/clinical personnel indicated a lack of standardization in the capacity assessment (CA) process at Caritas sites. To address the issue, an Interdisciplinary Caritas CA Working Group was created in January, 2006 to develop a systematic approach to CA. METHODS A Staff Survey was conducted to inform on the current process of assessments, a CA model was created, and the CA Demonstration Project was implemented on medical units at each of the Caritas sites beginning January, 2007. Data were collected from patient charts to analyze utility of the model. Referrals to Geriatric Consult Service were recorded to determine potential need for expansion of the project. RESULTS The survey results were used in the development of the model. The goals were: 1) development of a systematic process, 2) concentration on front-end screening and problem-solving, 3) definition of interdisciplinary roles, 4) organization and documentation of CA information, and 5) implementation of education. To date, twelve patients (mean age = 72.2) from the two units have had CAs initiated. Eleven triggers were validated, with the most commonly affected domains including healthcare, residence, personal and financial. Ten cases (83%) were resolved through problem-solving, thereby avoiding formal capacity assessment. Two patients were found to lack capacity. Social workers, nurse practitioners, occupational therapists and psychologists were most commonly involved in the interdisciplinary assessment. Additionally, there have been 79 referrals to Geriatric Consult Service from other units at the two sites since project initiation for primary reason of CA. Of these, 59 (75%) were from Medicine. CONCLUSIONS This model has been effective in streamlining CAs, preventing unnecessary formal CAs and increasing staff knowledge and skill set. CAs continue to be an area of concern in various programs, particularly Medicine. As a result, this project has been approved for implementation on all Medicine teams/units at two sites, with educational workshops already planned. Jasneet Parmar, Site Leader, Geriatrics, Misericordia Community Hospital, Caritas Health Group (Jasneet.Parmar@capitalhealth.ca) Anna Braslavsky, Project Analyst, Misericordia Community Hospital, Caritas Health Group (ab14@ualberta.ca) #4C4, 16940 – 87 Avenue, Edmonton, Alberta, T5R-4H5  CARE MAP SURVEY RESULTS QuestionResponseFrequency 1. Major problem or difficulty Lack of coordination of roles and responsibilities16 Lack of time to complete assessments13 Oversimplified notions of capacity11 Lack of standardization in the process8 Conflicts with discharge planning5 2. Level and quality of education and expertise in capacity assessment No formal training to perform capacity assessments10 Widespread education needed6 Not enough knowledge6 Varying degrees of knowledge5 Little understanding of legal aspects4 3. TeamworkFairly cohesive team8 Not working well together8 Heavy reliance on chart, but it doesn't relay pertinent information well 4 Incomplete/fragmented work from some members of the team 4 Good communication between disciplines3 4. Choice of modelsUnit-based3 Team-based for early implementation; later dispersal to unit-based 2 Mixture: team of "experts" that use existing staff for information 2 Flexible approach1 Hospital-wide team1 5. Suggestions for improvement Consistent methods and model (legally and medically)14 Define roles and responsibilities of each discipline8 Widespread education6 Front-end problem-solving5 More efficient throughput of patients5 DEMONSTRATION PROJECT Age (mean)72.2 GenderF = 7 (58%) Number of valid triggers11 Number of cognitive assessments performed (mean)2.2 MMSE score (mean)20.6 Number of cases resolved through problem-solving10 (83%) Number of patients found to lack capacity2 (17%) Data Log Information INTERACTIVE EDUCATIONAL WORKSHOPS Age (mean, range)40.8, 22 - 66 GenderF = 58 (89%) Length of time worked in current settingLess than 1 year: 29.2% 2 -5 years: 33.8% 6 or more years: 36.9% Training in CANone: 57.6% Previous training: 42.4% Disciplines representedCNE (6.2%), NP (7.7%), OT (15.4%), RN (21.5%), SW (30.0%), Other (19.2%) Demographics / Descriptives Question% Unaware pre- workshop % Unaware post-workshop % Change 1. Concept of “capacity”23.02.021.0 2. Pitfalls of CA41.00.041.0 3. Legislative Acts – CA56.02.054.0 4. Concept of “trigger”59.00.059.0 5. Domains of decision- making 41.03.038.0 6. Problem-solving techniques 62.52.060.5 7. Role of functional assessments 25.00.025.0 8. Role of cognitive assessments 88.90.088.9 9. My discipline’s role in CA43.83.040.8 10. Multidisciplinary approach 44.42.042.4 11. Standardized model for CA 64.02.062.0 12. System of documentation for CA 68.02.066.0 13. Confidence in skill-set77.85.072.8 14. Reasons for full CA56.09.047.0 15. Comfortable performing CA 56.03.053.0 Results