Having a DoLS or “Deprivation of Liberty Safeguard” in place means that staff at the patient’s place of treatment, have the legal ability to prevent them from leaving when it is deemed they lack the mental capacity to decide for themselves.
The reason these safeguards exist is for the greater good of the patient, although the process of a DoLS allows the patient or their family members to challenge the decision if they feel it’s unnecessary. It’s vital this is discussed with friends and family so everyone is on the same page and working towards the same goal of ensuring the patient’s well being and safety. DoLS can be revoked when/if a patient improves and it is really important to let loved ones know when/why/if an order such as this is being put in place.
I had a recent experience involving a patient who was suffering from vascular dementia, where it was stated in handover that he had a DoLS in place. He was a very calm man most of the time and although he was very confused at times, he was aware that he had dementia and lots of things were now decided for him by staff and his wife to protect his best interests. Day after day I would hear it in handover “This gentleman is under a DoLS, as he has requested to leave many times and doesn’t understand that he would be vulnerable”. Because he was so confused, no one doubted or questioned it, especially as it would be hazardous for him to go outside alone, not just socially but physically.
This gentleman was originally admitted to treat his leukaemia, following chemo his white cell count was severely depleted so his immune system was really low which would make him very poorly if he came into contact with even the common cold.
After about 2 weeks of being handed over has having a DoLS, we discovered that in fact, no such order had been put in place. It was requested, but the site team whose responsibility it was to actually fill out the paperwork, never did it. So we had, all the while been telling this chap, he wasn’t allowed to leave and his wife and his doctors had agreed this is what’s best for him, when in fact legally, he had every right to leave.
What I learnt from this experience was how essential good communication skills are. I think this is something we all take for granted too often in this profession. I know when I started I was very confident in my communication and thought having a unit on it was pretty silly but there were two big lapses of communication here that went unnoticed for days. Firstly it must have been handed over that we had applied for a DoLS and it subsequently got distorted into we had a DoLS – poor/rushed handovers happen all too often and this was the result. And secondly, the Multidisciplinary communication must have failed or else the site team would have followed through with the directives given to them. Luckily, we swiftly got the order correctly applied to this man and his family was very understanding, but when it comes to legal statements such as a DoLS or a DNAR as soon-to-be registered Nurses, it’s vital we know the information we are acting on is reliable and sound and as a student it’s crucial we learn to question things like this. If there is no evidence in the patient’s notes or medical information – do not act on word of mouth, one day it’ll be your PIN on the line and you want to be confident with every move you make.
Age UK has produced a really helpful fact sheet about DoLS – read it here