Why use SMART?

Patients with Disorders of Consciousness are often difficult to diagnose. Unless provided with an up-to-date, comprehensive, structured and standardised assessment, potential consistent or meaningful responses may be missed or not fully explored. This, in turn, can lead to:

• misdiagnosis and possibly withdrawal of nutrition and hydration
• inaccurate allocation of resources for future patient management

Potential reasons for insufficient assessment of this patient group may be as follows:

• Limited experience amongst some of the team working with this specific patient group.
• Inadequate time to provide appropriate and frequent assessment due to clinical climate and workload.
• The assessment techniques used do not possess the full range of methods and techniques required to identify the patient’s behavioural repertoire, wakefulness, response to stimuli and communication.
• The assessment techniques do not fully involve family, friends and carers – those who know the patient best.
• A team or individual use their ‘own’, ‘one-off’ assessment or a less sensitive assessment which does not provide the same level of accuracy.
• The lack of availability of a systematic assessment tool leads to team members establishing different assessment protocols and identifying a range of approaches and methods of communication, often resulting in confusion.

A Judge recently made a landmark ruling to  ensure that SMART assessments are carried out in all future court cases in relation to determining patient awareness levels which could potentially lead to their nutrition and hydration being removed.