Covert Medication Policy

COVERT  MEDICATION  POLICY  Reviewed 7th June 2012

BACKGROUND  

With respect to the prescribing, supply, storage and administration of medicines, this home adheres fully to The Health and Social Care act 2008, the Medicines Act 1968, the Misuse of Drugs Act 1971, the Misuse of Drugs (Safe Custody) Regulations 1973 and the Nursing and Midwifery Council (NMC) Guidelines for the Administration of Medicines.  

The home adheres to guidance provided by the Royal Pharmaceutical Society of Great Britain (RPSGB) in its publication, The Handling of Medicines in Social Care.  

For the purposes of this policy, the home understands covert medication to refer to medication which is given when a service user 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.  

The administration of medication covertly should apply only in respect of service users who lack mental capacity to give their consent or take a decision about the taking of any prescribed medication.  In these cases the home’s procedures are in accordance with the principles and practice guidance issued with the Mental Capacity Act 2005.  All decisions that are taken thus on service users’ behalf result from a full assessment of their mental capacity.  The decision then follows the ‘best interest’ principle of the Mental Capacity Act and is achieved and implemented only with the full involvement and agreement of the service user’s medical practitioner. 

 

POLICY  

In this home, medication should always be administered on a consenting basis with the full agreement and understanding of the service user and their relatives wherever possible.  However, the home does recognise that there may occasionally arise exceptional circumstances where a service user, 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 service users consent may be necessary where the service users 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:  

1.         All medication should be administered with the full knowledge and consent of service users wherever possible and every effort should be made by staff to obtain that consent.  

2.         Covert medication should only ever by seen as a last resort and as an emergency procedure, rather than routine, and care staff should discuss the case with the service user’s GP and relatives and obtain their written consent and approval prior to any covert administration of refused medication.  

3.         All cases must also be discussed fully with the pharmacist prior to administration.  

4.         Where service users can make a decision, refusal of treatment should be respected.  

5.         All service users 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 process6.         Any decision to administer medication in a covert way must be recorded in the relevant service user’s plan and all details of medication administered in this way must be recorded in the service user’s records and in their medication records. A risk assessment must be performed.7.         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.

      8.         The method of administration of medicines should be agreed with the pharmacist and all such cases should be regularly reviewed with the service user’s GP, pharmacist and relatives.

      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 service user’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.  

      STAFF CONDUCT 

      Staff are warned that any attempts to administer medications covertly that do not comply with the home’s policy and procedures are liable to internal disciplinary action. In serious cases which are tantamount to abuse, staff could face a police investigation and referral to the Protection of Vulnerable Adults (POVA) list if they are found guilty of misconduct as a result.

      Training 

      Training on the home’s policies regarding the covert administration of medication is included in the home’s induction training on the administration of medication, which achieves the Common Induction Standards set by Skills for Care.

      All staff responsible for the administration of medication receive accredited training and are expected to be able to administer the home’s policies, particularly in respect of service users who lack mental capacity to take the necessary decisions concerning their medication.

      Staff are expected to keep themselves up to date as specified in NMC guidelines for the administration of medicines.

       

      Signed:                      ____________________________________

      Date:                           ____________________________________

      Policy review date:   ____________________________________

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