The administration of covert medication can be controversial and can lead to misunderstanding and confusion. The following is a brief summary of guidance on the matter which I hope will be of interest.
NICE definition of covert administration
“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.”
NICE quality statement
“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.”
NICE go on to say:
“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.”
In considering then particular issue of covert medication, in the context of DoLS, District Judge Bellamy (Case - AG v BMBC & Anor  EWCOP 37) provided the following helpful guidance:
Selected extract from judgment
“(a) Where there is a covert medication policy in place or indeed anything similar there must be full consultation with healthcare professionals and family.
(b) The existence of such treatment must be clearly identified within the assessment….
(c) ….there should be a clear provision for regular, possibly monthly, reviews of the care and support plan.
(d) There should at regular intervals be review involving family and healthcare professionals…..
(g) Any change of medication or treatment regime should also trigger a (DoLS) review where such medication is covertly administered.”
Medication can therefore only be prescribed covertly for those people who lack the mental capacity to give informed consideration and consent or refuse such medication.
A specific capacity assessment must be recorded and available in care records.
Other than in emergency situations, NICE recommend that a decision to administer medication covertly must be reached following a best interest meeting on the matter.
A meeting should include relevant health professionals and family/friends.
An administration plan should be documented and include how the medicine is to be administered and it should be prescribed in this manner.
The use and continued need for covert medication must be regularly reviewed and this should include the person who is overseeing the prescription of the medication.
It is also worth stressing that measures should also be put in place to ensure that the medication cannot be accidentally taken by another person who may inadvertently eat or drink it.
Desuto decision support and reporting tools guide people through the capacity assessment process and document the full assessment process and conclusion. The best interest tool can be used to document any decision reached at a meeting and the DoLS tool used to make an application to the local authority in the case of this and other restrictions.