Quality statement 6: Covert medicines administration
Adults who live in care homes and have been assessed as lacking capacity are only administered medicine covertly if a management plan is agreed after a best interests meeting.
The covert administration of medicines should only be used in exceptional circumstances when such a means of administration is judged necessary, in accordance with the Mental Capacity Act 2005. However, once a decision has been made to covertly administer a particular medicine (following an assessment of the capacity of the resident to make a decision regarding their medicines and a best interests meeting), it is also important to consider and plan how the medicine can be covertly administered, whether it is safe to do so and to ensure that need for continued covert administration is regularly reviewed (as capacity can fluctuate over time). Medicines should not be administered covertly until after a best interests meeting has been held. If the situation is urgent, it is acceptable for a less formal discussion to occur between the care home staff, prescriber and family or advocate to make an urgent decision. However, a formal meeting should be arranged as soon as possible.
Evidence of local arrangements to agree a management plan after a best interests meeting in which a decision is made to covertly administer medicines to an adult care home resident.
Data source: Local data collection.
Proportion of adults in a care home being covertly administered medicine who have a record of a best interests meeting and management plan.
Numerator – the number in the denominator with a record of a best interests meeting and management plan.
Denominator – the number of adults in a care home being covertly administered medicine.
Data source: Local data collection.
Service providers (care homes) ensure that if a decision is taken to covertly administer medicine to an adult care home resident, then a management plan is also agreed and recorded after a best interests meeting.
Health and social care practitioners who participate in a best interests meeting agree and record a management plan after the best interests meeting if a decision is taken to covertly administer medicine to an adult care home resident.
Commissioners (local authorities) ensure that service specification contracts for care home providers include a requirement to ensure that if a decision is taken to covertly administer medicine to an adult care home resident, then a management plan is also agreed and recorded after a best interests meeting.
Adults who live in care homes who may not be able to make decisions about their treatment and care may need to be given their medicines without them knowing (known as 'covert administration'), for example hidden in their food or drink. Care home staff should have a meeting with healthcare professionals and family members to discuss this and agree whether it is the best option for the person. If it is agreed, a plan should be made after the meeting to make sure it is done safely and reviewed regularly to check if it should continue.
Managing medicines in care homes. NICE guideline SC1 (2014), recommendation 1.15.3
When covert administration of medicines is being considered, there should be a 'best interests' meeting. The purpose of this meeting is to agree whether administering medicines without the resident knowing (covertly) is in the resident's best interests. A best interests meeting should be attended by care home staff, relevant health professionals (including the prescriber and pharmacist) and a person who can communicate the views and interests of the resident (this could be a family member, friend or independent mental capacity advocate depending on the resident's previously stated wishes and individual circumstances). If the resident has an attorney appointed under the Mental Capacity Act for health and welfare decisions, then this person should be present at the meeting.
When medicines are administered in a disguised format without the knowledge or consent of the person receiving them, for example in food or in a drink.
This would usually include:
medication review by the GP
medication review by the pharmacist to advise the care home how the medication can be covertly administered safely
clear documentation of the decision of the best interests meeting
a plan to review the need for continued covert administration of medicines on a regular basis.