353:
507:
221:(also called concealed, hidden or surreptitious medication), the covert administration of medicines is when medicines are administered in a disguised form, usually in food or drink, without the knowledge or consent of the individual receiving the drug. The decision-making processes surrounding covert medication should be in the best interests of the patient, transparent and inclusive.
283:, can be reduced when mixed with food, particularly dairy products. Some medicines are incompatible with various minerals including calcium, iron, magnesium, and zinc, all of which may reduce absorption. Crushing slow-releasing tablets or enteric coated medicines may also reduce absorption of the medicines.
302:
In the UK guidelines state that individuals should be medicated covertly for as short a period of time as possible and their medication should be reviewed regularly, with decision making documented. In New
Zealand there is not any guidance on decision making surrounding covert medication for nurses.
646:
to make decisions for themselves. In this situation, a management plan is agreed in the best interests of the patient. This involves a meeting with healthcare professionals, care home staff and an independent reviewer, such as a family member, friend or independent mental capacity advocate.Capacity
692:
Regarding covert medication within families, Guidry-Grimes, Dean and Victor argue that covert medication by a family member may cause more relational damage and represent a greater violation of trust. They argue that the lack of healthcare services, such as in India, may contribute to covert
634:
under the Mental Health Act to be kept in hospital, possibly against their wishes, particularly if they are at risk of harm to themselves, harm to others and harm from others. The Mental Health Act is limited to treatments of a patient's mental health. Under the Mental Health Act, it is not
255:, patients experience memory loss and can have impaired decision-making skills. As a result, their capacity to consent to medication is impaired. In these cases medication may be covertly administered, as is the case in nursing homes. Impaired capacity is also seen in patients with
259:. These patients may exhibit behaviours that challenge or symptoms of mental ill health, for which medication is used to reduce risk of harm to self or others. The best interest of the patient are considered when making decisions. Patients with mental health disorders, such as
247:
and care homes. In the care of paediatric patients, young children may be unwilling to take medication with an unpleasant taste or smell, or due to fear of the unfamiliar. In these cases, the medication may be mixed with food or drink to make it more acceptable.
1240:
610:
5(4) "Everyone who is deprived of his liberty...shall be entitled to take proceedings by which the lawfulness of his detention shall be decided speedily by a court and his release ordered if the detention is not lawful."
224:
Research suggests that covert administration of drugs is an embedded practice in nursing homes for the elderly in New
Zealand. 43-71% of nursings homes in the United Kingdom acknowledge the practice.
775:
689:
that may depend on these relationships, particular if medication is covertly added to food since food, its production and its mutual consumption can be an element of relationships.
697:
than others with the family acting as a form of collective which could reduce the sense of violation if a family member engages in covert medication towards another family member.
555:
to make decisions about accepting or refusing medication. In these situations, it may be appropriate to covertly administer medication, after other measures have been attempted.
585:
and has several implications for mental health patients. Relevant articles concerning mental health and covert medicine administration in the Human Rights Act are listed below:
671:
applies to the administration of medication and treatment for any condition covertly. This is in contrast to the Mental Health Act, which applies to mental health, as above.
510:
1134:
626:
is an Act passed through
Parliament in the United Kingdom which applies to people in England and Wales. In specific circumstances, this overrides certain fundamental
647:
should be assessed each time a new medical decision is made, as the ability to give valid consent can fluctuate, particularly in those with mental health disorders.
313:
Nursing guidelines in the New
Zealand state the overriding a patient's wishes to not receive medication if the healthcare worker perceives it to be in the patient's
1353:
205:
294:
of many medicines by decreasing the rate of elimination. This alters drug levels in the blood which may cause side effects or make the drug less effective.
1328:
534:
306:
In the UK, NHS trusts may publish guidelines concerning administration of covert medication. Guidelines often include flowcharts to aid decision making.
809:
Garratt SM, Jonas MF, Peri K, Kerse N (September 2021). "To crush, or not to crush? Unauthorised covert administration of medication in nursing homes".
310:
recommends care home providers have a care home medicines policy that includes guidance on covert administration of medications by care home staff.
551:
that all persons have the right to refuse medication, and this right is often enshrined in national law. In some situations, patients may lack
1303:
663:
The person is judged not to have the capacity to understand the consequences of their refusal, determined by the Mental
Capacity Act 2005.
198:
1362:
748:
235:
Covert administration of medication is practised in a range of medical specialities and across a variety of care settings including
607:
5(2) "Everyone who is arrested shall be informed promptly, in a language which he understands, of the reasons for his arrest..."
604:
5(1) "Everyone has the right to liberty and security of person save ... (e)the lawful detention...of persons of unsound mind..."
527:
275:
Covert administration of medication typically involves mixing the medication with food or drink. This can have an impact on the
1427:
191:
1215:
548:
643:
318:
582:
685:
Guidry-Grimes, Dean and Victor theorize that covert medication may damage relationships and as a result an individual's
520:
434:
1278:
402:
902:
Akram G, Mullen AB (April 2015). "Mixing medication into foodstuffs: identifying the issues for paediatric nurses".
1573:
693:
medication by family members. Responding, Pickering argues that certain cultures may be more collectivist and less
565:
It is determined to be essential to the patient's mental or physical health, and therefore in their best interest
267:, may lack insight into their mental health symptoms. They refuse medication due to the belief it is not needed.
1383:
937:
Raghavan R (2010). "Ethical issues of psychotropic medication for people with intellectual disabilities".
638:
Generally, to receive any kind of health treatment, you need to give consent. In
England and Wales, the
1568:
264:
966:"Covert medication; the last option: A case for taking it out of the closet and using it selectively"
276:
668:
639:
568:
The patient is deemed to lack capacity to understand the repercussions of refusing the medication.
232:
Medication is sometimes administered covertly by crushing pills and adding them to food or drink.
256:
156:
1015:
623:
398:
109:
68:
59:
1507:"Covert medication and patient identity: placing the ethical analysis in a worldwide context"
1455:"Covert medication and patient identity: placing the ethical analysis in a worldwide context"
578:
408:
393:
352:
73:
31:
593:"No one shall be subjected to torture or to inhumane or degrading treatment or punishment"
413:
314:
135:
8:
470:
321:
can be covertly medicated; capacity may be assessed by the prescriber of the medication.
1241:"Deception in Caregiving: Unpacking Several Ethical Considerations in Covert Medication"
1539:
1506:
1479:
1454:
1189:
1164:
1070:
1045:
992:
965:
834:
50:
1401:
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1526:
1484:
1260:
1194:
1180:
1116:
1075:
997:
919:
884:
876:
838:
826:
727:
635:
appropriate to give medicines covertly to treat physical health, only mental health.
460:
344:
140:
104:
45:
1534:
1518:
1474:
1466:
1252:
1184:
1176:
1106:
1065:
1057:
987:
977:
946:
911:
868:
818:
444:
303:
There is no legislative guidance in
Ontario in Canada for deception in healthcare.
98:
1522:
1470:
872:
716:"Covert medication in psychiatric emergencies: is it ever ethically permissible?"
491:
439:
291:
287:
715:
680:
552:
496:
324:
In some facilities in New
Zealand, it is standard practice for nurses to ask a
164:
114:
94:
1562:
1530:
1264:
1256:
1135:"Pharmaceutical Issues when Crushing, Opening or Splitting Oral Dosage Forms"
982:
880:
694:
642:
sets out legislation criteria and procedure for patients who do not have the
475:
367:
260:
174:
160:
1111:
1094:
950:
1548:
1488:
1120:
1079:
1001:
923:
888:
830:
731:
686:
627:
119:
1198:
857:"Covert administration of medication in food: a worthwhile moral gamble?"
372:
280:
240:
78:
1061:
855:
Guidry-Grimes, Laura; Dean, Megan; Victor, Elizabeth Kaye (2021-06-01).
856:
630:
mentioned above. For example, those with mental health problems can be
465:
418:
325:
244:
236:
1329:"Managing medicines for adults receiving social care in the community"
915:
822:
631:
252:
168:
804:
802:
800:
798:
796:
317:
In the United
Kingdom, only patients who have been deemed to lack
660:
The medication is deemed essential to their health and wellbeing.
793:
650:
Covert administration is only necessary and appropriate where:
1216:"Covert administration of medicines - Care Quality Commission"
558:
Medication is only likely to be administered covertly where:
720:
The
Journal of the American Academy of Psychiatry and the Law
1428:"Administering medicines covertly | Care Quality Commission"
307:
286:
Mixing medications with food or drink may also affect the
1163:
Bailey DG, Malcolm J, Arnold O, Spence JD (August 1998).
1162:
377:
939:
Advances in Mental Health and Intellectual Disabilities
854:
290:
of the drug. For example, grapefruit juice changes the
808:
1099:
Acta Scientiarum Polonorum. Technologia Alimentaria
279:of the drug. Absorption of some medicines, such as
776:"Covert administration of medicines in care homes"
1560:
713:
1304:"Covert Administration of Medication Flowchart"
1283:Coventry and Rugby Clinical Commissioning Group
1043:
619:"Right to respect for private and family life"
1095:"Food and drug interactions: a general review"
714:Hung EK, McNiel DE, Binder RL (1 April 2012).
811:International Journal of Older People Nursing
528:
199:
1092:
773:
901:
562:The patient actively refuses their medicine
1363:National Institute for Clinical Excellence
1309:. Cardiff and Vale University Health Board
535:
521:
206:
192:
1538:
1504:
1478:
1452:
1188:
1110:
1069:
1044:Bushra R, Aslam N, Khan AY (March 2011).
991:
981:
904:International Journal of Nursing Practice
1169:British Journal of Clinical Pharmacology
1016:"Good Practice Guide: Covert Medication"
936:
1561:
1500:
1498:
1378:
1376:
1374:
1372:
1238:
1023:Mental Welfare Commission for Scotland
743:
741:
1245:Journal of Law, Medicine & Ethics
1210:
1208:
707:
654:A person actively refuses a medicine.
549:Universal Declaration of Human Rights
16:Disguised administration of medicines
1165:"Grapefruit juice-drug interactions"
963:
850:
848:
774:Kelly-Fatemi B (19 September 2016).
749:"Medicines management in care homes"
1495:
1420:
1369:
738:
583:European Convention of Human Rights
581:, part of UK law, incorporates the
13:
1205:
435:Obligatory Dangerousness Criterion
297:
14:
1585:
845:
572:
1181:10.1046/j.1365-2125.1998.00764.x
601:"Right to liberty and security"
506:
505:
351:
1446:
1394:
1346:
1321:
1296:
1271:
1239:Abdool, Rosalind (Roz) (2017).
1232:
1156:
1127:
1086:
1037:
331:
1453:Pickering NJ (December 2020).
1279:"Covert medication flow chart"
1144:. Royal Pharmaceutical Society
1008:
957:
930:
895:
767:
1:
1523:10.1136/medethics-2020-106695
1505:Pickering, Neil John (2021).
1471:10.1136/medethics-2020-106695
873:10.1136/medethics-2019-105763
700:
970:Indian Journal of Psychiatry
547:It can be inferred from the
328:before crushing medication.
7:
1093:Ötles S, Senturk A (2014).
10:
1590:
1402:"Mental Capacity Act 2005"
1390:. Open Government Licence.
780:The Pharmaceutical Journal
678:
265:bipolar affective disorder
1511:Journal of Medical Ethics
1459:Journal of Medical Ethics
1434:. Care Quality Commission
1408:. Open Government Licence
1355:Giving medicines covertly
861:Journal of Medical Ethics
674:
270:
1257:10.1177/1073110517720648
1046:"Food-drug interactions"
983:10.4103/0019-5545.102427
640:Mental Capacity Act 2005
227:
1574:Medication pharmacology
1384:"Human Rights Act 1998"
1112:10.17306/j.afs.2014.1.8
951:10.5042/amhid.2010.0541
257:intellectual disability
157:Intramuscular injection
1406:www.legislation.gov.uk
1388:www.legislation.gov.uk
399:Involuntary commitment
110:Mental health tribunal
69:Involuntary commitment
60:Involuntary commitment
964:Kala AK (July 2012).
409:Outpatient commitment
394:Involuntary treatment
74:Outpatient commitment
32:Involuntary treatment
1050:Oman Medical Journal
817:(5). Wiley: e12393.
414:Voluntary commitment
136:Voluntary commitment
1062:10.5001/omj.2011.21
669:Mental Capacity Act
657:It is safe to do so
471:Chemical castration
461:Psychoactive drugs
453:Current procedures
245:geriatric medicine
51:Chemical restraint
46:Physical restraint
1569:Mental health law
916:10.1111/ijn.12222
823:10.1111/opn.12393
624:Mental Health Act
545:
544:
345:Mental health law
219:Covert medication
216:
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180:Covert medication
141:Informal coercion
105:Mental health law
26:Part of series on
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579:Human Rights Act
537:
530:
523:
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508:
355:
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335:
208:
201:
194:
99:Informed consent
23:
22:
1589:
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1578:
1559:
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1496:
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1333:NICE guideline
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695:individualistic
683:
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440:Duty to protect
334:
319:mental capacity
300:
298:Decision-making
292:bioavailability
273:
230:
212:
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1432:www.cqc.org.uk
1419:
1393:
1368:
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1295:
1270:
1251:(2): 193–203.
1231:
1220:www.cqc.org.uk
1204:
1175:(2): 101–110.
1155:
1126:
1085:
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976:(3): 257–265.
956:
929:
910:(2): 125–131.
894:
867:(6): 389–393.
844:
792:
766:
737:
726:(2): 239–245.
705:
704:
702:
699:
681:Medical ethics
676:
673:
665:
664:
661:
658:
655:
574:
573:United Kingdom
571:
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563:
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315:best interest.
299:
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165:Benzodiazepine
151:
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95:Medical ethics
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1105:(1): 89–102.
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1025:. Spring 2017
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1436:. Retrieved
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1336:. Retrieved
1332:
1323:
1311:. Retrieved
1298:
1286:. Retrieved
1282:
1273:
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1234:
1223:. Retrieved
1219:
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1158:
1146:. Retrieved
1141:
1129:
1102:
1098:
1088:
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