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Evidence-base: Deprivation of Liberty Safeguards (DOLS) addresses processes by which best interest decisions are made for vulnerable patients. DOLS forms part of the Mental Capacity Act but has not been given much prominence despite its clinical and ethical relevance. This audit evaluated local understanding, recognition and reporting processes of DOLS in a DGH. A quantitative survey was performed using a paper-based questionnaire targeted at all healthcare professionals. During the initial audit (n = 59), on-the-job DOLS teaching was available. The initial survey revealed 29% (n = 17) of healthcare professionals recognised the need for a DOLS and only 31% (n = 18) described the correct reporting process.

Change-strategies: The initial stage of the audit illustrated the need for more robust interventions than education alone. In collaboration with the Trust's Safeguarding team, an algorithm (DOLS Action-Bundle) was formulated focusing on local deficiencies in knowledge and clinical practice, and made widely available. In addition, focused training sessions were planned. Due to time constraints, these sessions were preferentially offered to doctors.

Change-effects: Post implementation of interventions, a further survey (n = 59) was conducted. Descriptive analysis revealed improvement in recognition of vulnerable patients (71%, n = 42) requiring DOLS across all healthcare professional groups. Similarly, 56% of staff (n = 33) correctly identified the reporting process. Sub-group analysis revealed a statistically significant improvement in both these domains amongst doctors (p < 0.05) which is particularly relevant as this was the group targeted during focused education sessions.

Conclusion: There is a paucity of knowledge regarding DOLS. Education alone is ineffective in making the required changes. Interventions incorporating focused education, development of DOLS Action-bundle and collaborative working with a safeguarding agency have impacted significantly on recognition and reporting of DOLS amongst doctors. Future plans include extension of focused education across all healthcare professional groups and identification of ward DOLS champions with a repeat audit to assess impact of changes.

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