With respect to the prescribing, supply, storage and administration of medicines, this home adheres fully to the Medicines Act 1968, the Misuse of Drugs Act 1971, the Misuse of Drugs (Safe Custody) Regulations 1973 and the Nursing and Midwifery Council Guidelines for the Administration of Medicines.
For the purposes of this policy the home understands covert medication to refer to medication which is given when a resident is unable to give consent because they cannot understand what they are being asked, and their GP or doctor thinks that their condition would be improved with the medication. The home understands that this represents a difficult and complex ethical area which needs to be approached with sensitivity and care.
In this home, medication should always be administered on a consenting basis with the full agreement and understanding of the resident and their relatives wherever possible. However, the home does recognise that there may occasionally arise exceptional circumstances where a resident, by virtue of their mental state or frailty, is unable to give that consent, despite the best efforts of staff to obtain it. In such situations the home accepts that the administration of medication without the residents consent may be necessary where the resident’s GP advises that the medication is in their best interests.
Therefore, in this home, covert medicines should only be administered according to NMC guidelines for covert medication administration as follows.
- All medication should be administered with the full knowledge and consent of resident wherever possible, and every effort should be made by staff to obtain that consent.
- Covert medication should only ever be seen as a last resort, rather than routine, and care staff should discuss the case with the resident’s GP and relatives and obtain their written consent and approval prior to any covert administration of refused medication. The decision to administer medication covertly must never be considered as routine.
- All cases must also be discussed fully with the pharmacist prior to administration.
- Where residents can make a decision, refusal of treatment should be respected.
- An assessment of mental capacity, as specified in the Mental Capacity Act 2005, should always be completed before the use of covert medication is considered. Those who are shown to have mental capacity and still refuse a medication should have their refusal respected. All resident’s should be presumed to have the mental capacity to consent or refuse treatment, unless they:
- are unable to take in and retain information
- are unable to believe that information
- are unable to “weigh-up” the information as part of a decision-making process.
- Any decision to administer medication in a covert way must be recorded in the relevant resident’s care plan and all details of medication administered in this way must be recorded in the resident’s records and in their medication records.
- Only medication which is considered essential for the patient’s or client’s health and well-being, or for the safety of others, should be considered for administration in a covert way.
- The method of administration of medicines should be agreed with the pharmacist and all such cases should be regularly reviewed with the resident’s GP, pharmacist and relatives.
- Staff should never crush tablet or capsule medication and mix it in with food or drink in order to administer it unless told they may do so by a pharmacist. This practice is potentially dangerous and may alter the properties of the tablet or capsule causing the resident to absorb the medication quicker than intended and suffer side-effects. Staff should seek the professional guidance of the pharmacist linked to the home who is in the best position to give advice on the suitability of methods of administration and the advice should be documented in the care plan.
It is important to stress that in this home the covert administration of medication should only ever be an absolute last resort and performed in exceptional circumstances, if at all, and with the resident’s best interests in mind at all times. Medication should never be administered in a covert way merely for the convenience of staff or of the home. Any abuse of the procedure will be viewed by the home as professional misconduct and as a serious disciplinary matter.
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