Covert Administration Flashcards
(15 cards)
What is overt administration?
Overt administration makes medicines more palatable or easier to take for the person. The person is aware that the medicine has been mixed into the food or drink and willingly consumes it via that route.
Overt administration can be open to abuse or misinterpretation.
What is covert administration?
Covert administration occurs when medicines are administered in a disguised format without the knowledge or consent of the person receiving them. The person is unknowingly taking medication.
Every patient has a right to refuse medication, even if it appears ill-judged by staff.
When is covert administration likely necessary?
Covert administration may be necessary when a person actively refuses their medicine, lacks the capacity to understand the consequences of their refusal, or when the medicine is deemed essential to their health and wellbeing.
Capacity is determined by the Mental Health Act 2005.
What does the Mental Capacity Act 2005 state about capacity?
The Mental Capacity Act 2005 emphasizes not to assume someone lacks capacity due to a medical condition or disability. Involving the person in decision-making is essential, and an unwise decision does not equate to a lack of capacity.
Actions taken on behalf of a person lacking capacity must be in their best interests.
What is required of care homes regarding medicines policy?
All care homes must have a medicines policy that clearly explains the covert medicines administration process. The policy should be specific to the setting and up to date.
Staff must read, understand, and follow the policy.
What is a ‘best interest meeting’?
‘Best interest meetings’ involve staff, healthcare professionals, pharmacists, and family members or advocates to agree whether administering medicines covertly is in the person’s best interest. This should be documented.
If urgent, a less formal discussion may be suitable.
What is the last resort regarding covert administration?
Covert administration must be the least restrictive option when all other options have been tried. It should be seen as a last resort, and normal administration should have been attempted first.
Consider specific reasons for the patient’s refusal, such as taste or timing.
What should happen before adding a new medication covertly?
Before adding any new medication covertly, an assessment of the need for covert administration and a ‘best interests meeting’ should take place.
How should covert administration be reviewed?
Covert administration should be used for the shortest time possible, with regular reviews of the continued need for it and consideration of fluctuations in capacity.
Who should be involved in decisions about covert administration?
Decisions about covert administration should not be taken alone; a multi-disciplinary team should be involved. Details of how the medicine is given covertly should include specialist input.
What records should be maintained for covert administration?
A clear record of which medicines have been given covertly should be maintained, especially for patients with fluctuating capacity. Actions taken to give medicines in the normal manner must also be recorded.
What should prescriptions state regarding covert administration?
Prescriptions should state full directions for the medication, such as ‘to be given covertly in food/drink’ or ‘crush and give covertly in food.’
What are pharmaceutical issues with covert administration?
Pharmaceutical issues include staff knowledge/training, alternative formulations, the relationship with food and drink, consequences of crushing/opening, and patient acceptability.
What factors should be considered regarding patient acceptability?
Factors include whether the medicine can be crushed, the taste, absorption with food, incompatibility with food or beverages, and safety of crushing tablets.
What is the general rule of thumb for covert administration?
1) Check the SPC for information on crushing. 2) Check for BNF warning labels related to food. 3) Look at NEWT for modified release. 4) Consider film coating formulations or MR formulations.
If no reason not to give within a mouthful of yogurt/fruit puree is found, it is probably safe to do so.
