Best practice guidance for COVID-19 swabbing

Guidance prepared, SCC updated 28/10/2020

Peter Hampton, Adult Safeguarding Manager & Liz Osburn, Lead Practitioner, MCA, DoLS & Safeguarding L&D1

Best Practice re COVID-19 Swabbing

All activity / decisions and reasons for these must be clearly recorded

Working with clients:

• who may need support with understanding reasons for test in order to give consent

• where an assessment of their capacity is deemed necessary

• where, following on from assessment, a best interests decision is required

• best interests decisions should be made on an individual basis. No automatic assumption should be made that was in the best interests of one person will be in the best interests of another, even if the 2 cases share similar characteristics.

Capacity assessment

This is decision specific – what does the person needs to understand – why testing is proposed and in context with current infection risk [ the relevant/ salient details of this- explanation does not need to be complicated]

• benefits of agreeing to the test

• • taking swabs is quick

• • no lasting discomfort

• • possible treatment to ease symptoms if positive result,- the importance of protecting the health of others

• burdens [potential]

• • the nature of the test - possible short-term discomfort

• • possible restrictions following on from result of test

This needs to be formally recorded: record the response of the person (words/actions) to the information provided above (even if there is no appropriate response).

Issues to consider

For provider to consider and share with the person:

• Environment – where is the test carried out?

• Who does this?  Consider relationship with the person.

• What support can be given in order to lessen any adverse impact upon the person?

• Consider worthwhile distraction – conversation, music, positive activity that they enjoy

How can the test be carried out effectively in the least restrictive way

If the person lacks capacity to give their consent

For many people, a best interests decision to test for COVID-19 will align with the decision that the person would have taken themselves if they had capacity for the protection of their own health, and others around them.

Targeted treatment, based on a positive test result, can improve lives (by reducing the severity and duration of symptoms), and in some cases, save lives. Testing an asymptomatic person at risk of infection, for example, can also identify infection earlier and improve outcomes for that person. Decision-makers should consider this context when making best interests decisions about testing.

Best Interests Decision Checklist

• What are the person’s views/ observed response/ opinion about this proposed test [a passive compliance will influence the decision maker when determining best interests]

• Consult with those significant to this decision – family - what are their views, who else is relevant?   Advocacy in the absence of family, GP, other professionals involved

• Least restrictive method of carrying out the test [see above but also question should the test be carried out at all – particularly where the person is not engaging or is resistive in behaviour] *

What about Physical Restraint?

Brings with it the risk of harm and is only lawful under the MCA if Section 5 and Section 6 of the MCA are observed:

Section 5 of the MCA clarifies that where a person is providing care or treatment for someone who lacks capacity then the person can provide the care without incurring legal liability. The key is an appropriate assessment of capacity and best interests.

Section 6 of the MCA defines restraint as the use or threat of force where an incapacitated person resists, and any restriction of liberty or movement (whether or not the person resists).

Restraint is only permitted if the person using it reasonably believes it is necessary to prevent harm to the incapacitated person, and if the restraint used is proportionate to the likelihood and seriousness of the harm.

Consider

Can the test may be carried out safely by distraction, positive intervention and methods applied as stated above?

Where the person is actively resisting and measures to achieve compliance are not successful, the test should not be carried out.