Covert Medication

NICE Guidance Helps to Reduce the Risks Posed by Covert Medication

Administering covert medication can be fraught with risks but new guidance from NICE aims to help care home managers ensure that medicines given covertly are administered safely and in service users’ best interests. 

Giving medicines covertly: A quick guide for care home managers and home care managers providing medicines support, is available from the NICE website and makes it clear that people should never be given medicines without their knowledge if they have the mental capacity to make decisions about their treatment and care. However, in circumstances where a person lacks capacity and giving medicines covertly e.g. in food or drink, can be justified as being in their best interests, care providers need to work within the framework on the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards, to protect both service users and themselves.

In cases where a service user declines to take their medication on a regular basis, you should always discuss this with the prescriber. In some instances, the medication could be stopped or an acceptable alternative prescribed. However, in situations where a person lacks capacity and withdrawing the medication could have an adverse effect on their health, covert medication may be necessary.

Follow These 5 Steps to Safe Covert Administration of Medicines:

  1. Complete a Mental Capacity Assessment: Capacity is decision specific so it’s essential that the service user’s ability to understand decisions about medication is assessed independently from any other assumptions of capacity. The most appropriate person to carry out this particular assessment of capacity is usually the prescriber.
  2. Hold a Best Interests Meeting: If the service user is assessed as lacking capacity to make decisions about their medication, a best interests meeting involving the prescriber, pharmacist, care home staff and a family member or advocate should be held. The aim of the meeting should be to establish if covert administration is in the person’s best interest and only once this decision is reached should medicines be given without the person’s consent.
  3. Maintain Accurate Records: A record of the meeting, including details of those involved in making the decision should be kept on the service user’s care records. The care plan and MAR chart should also be updated to reflect the outcome of the meeting.
  4. Involve the Pharmacist: Speak to your pharmacist to agree the best way to administer each medicine safely. Not all medicines call be mixed with food or drink or exposed to high temperatures so you should provide clear instructions and training to all staff on how covert medicines are to be given.
  5. Undertake Reviews: As with any other plan, it’s essential to carry out regular reviews to ensure it remains appropriate. Always consider whether the person may regain capacity and if the medication prescribed is still needed, particularly in the case of antipsychotic drugs which may have significant side-effects.