As Sid* required a blood test under sedation, a Serious Medical Treatment (SMT) referral was made to Advocacy Focus. Sid, who lived in a care home, was deemed to lack capacity about the decision and had a phobia of needles.

How we helped

The Independent Mental Capacity Advocate (IMCA) spent time with Sid in his home, consulted with staff and reviewed his documentation, which supported that Sid had a needle phobia. The IMCA requested that staff at the home engage Sid in regular discussions about the treatment, in addition to the discussions that the IMCA was having with Sid.

From visiting Sid, the IMCA was able to determine that Sid didn’t like needles, that he wanted to go to hospital for a blood test, and other factors which would support the procedure going ahead. From building a positive relationship with Sid the IA also found out that he liked certain TV programmes and music and that he had better relationships with certain staff members.

The IMCA attended a Best Interest Meeting and represented Sid in bringing the above information forward. They also requested that the decision maker take into consideration the principles of the Mental Capacity Act, and look at less restrictive alternative options to sedation for the blood test.

It was decided that sedation may be in Sid’s best interests, due to his needle phobia and lack of capacity relating to the decision. However it was agreed that the least restrictive principle would be followed in regards to this.

The following plan was formulated:

  • In the first instance a local anaesthetic cream and cold spray would be applied. A barrier would be erected to block Sid’s line of sight, so that he could not see the procedure, thus minimising distress. Sid would also have someone supporting his arm to ensure safety of the procedure and to further block Sid’s vision of this. The blood test would be taken from the back of Sid’s hand.
  • If this was unsuccessful, the second stage would involve the decision maker administering an oral anaesthetic, mixed with juice. The IMCA asked the decision maker to consider informing Sid of this, to avoid the medication being administered covertly. Once the medication has taken effect, the blood test could be completed.
  • If the second stage was unsuccessful then the decision was to be returned to the GP to consider further actions.
  • Due to Sid’s needle phobia, he was not be advised of the moment the blood test was to commence.
  • Due to there being a possibility of Sid requiring oral sedation (second stage), he was to be nil by mouth on the day of the blood test. It was identified that this may be problematic for staff to monitor, due to Sid’s fixation with food, it was decided that although Sid would be made aware of the plan, he would not be informed of the date of the test until the date itself. This was because Sid wakes early in anticipation of appointments, and ensuring he does not eat for a prolonged timeframe would prove difficult. Furthermore, the appointment was to be as early as possible, so that Sid would not be subject to nil by mouth for a prolonged period.

The first stage proved successful, Sid had a blood test with no sedation required, thus resulting in the least restrictive option being in his best interests. This was as a direct result of the IMCA highlighting to the Decision Maker the importance of complying with the Mental Capacity Act principles and considering the least restrictive option.  

*Names have been changed to protect the identity of the people we support