During the examination, healthcare professionals should consider how long the patient refused to take medication or irregularly, as well as the consequences of this assumption. For example, if a patient has not taken their antihypertensive medications for two weeks, but their recent blood pressure readings are within acceptable settings, it may be more appropriate to proceed without medication and review this decision at defined intervals. It may seem obvious, but it`s easy to forget, forget how important a medication is when you`re trying to deal with other considerations, such as formal procedures and whether the tablets can be crushed. A prescribing physician must authorize secret administration of drugs Taken together, the articles in this edition of the symposium show how the lack of guidance on secret drugs poses significant challenges for patient care, health care providers and healthcare organizations. We reflect critically and comprehensively on several legal, ethical and professional considerations that should guide and support policy development and practice as a platform for future discussions on this practical topic. Pharmacists and health care professionals should be familiar with secret drug administration, a complex process that requires multidisciplinary assessment to ensure their appropriate use in nursing homes. If they are unable to make these decisions and it is deemed in their best interests, they may need to receive medication without their knowledge or consent (e.g., hidden in food or drink). Carers need to be aware of the Mental Capacity Act and its Code of Conduct, as well as custody guarantees, in order to protect both the person and themselves. Help people make informed decisions about their medications whenever possible. If they refuse their medication and are able to make this decision, nurses should note that they refused and the reason (if a reason is given) in the medication administration record (MAR). If this happens regularly or may pose a risk to the person`s health, ask the prescribing physician to review the person`s treatment. It may be possible to stop the medication or prescribe an alternative.
Use secret administration for as short a period of time as possible. Think about what steps you will take if the person has fluctuating abilities. If a person has fluctuating ability, the service should have a secret plan. You can only use the plan if the person is unable to do so. For more advice, please contact medicines.enquiries@cqc.org.uk It is important to check why a person is refusing their medication. If this can be corrected, secret administration may not be necessary. The National Guidelines on Secret Drug Administration provide further details and can be obtained from: They must determine the need for secret administration for each prescribed drug. Whenever new drugs are added or the dose of an existing drug changes, you should: Secretive drug administration is surprisingly common in health care, but at the same time, it is greatly underestimated due to a lack of guidelines for this practice.
Because the use of secret drugs has potential legal, ethical, and practical implications, health care providers are reluctant to admit their use, leading to under-reporting. Reference Kellett, Griffith, Bell, Short and Adshead1 Only 40% of secret drug administration is actually documented in the patient`s chart after administration. Reference Kirkevold and Engedal2 A preliminary study from 2001 showed that a significant proportion of patients (up to 79% in some care homes and hospital wards) in the UK receive secret medicines. Reference Treloar, Beats and Philpot3 Another study shows that in Norwegian nursing homes and specialist dementia wards, between 10 and 14% of patients receive secret medicines. Reference Kirkevold and Engedal4 Moreover, scattered surveillance leaves the door wide open to the overuse of secret drugs when they are legally, ethically and professionally indefensible, and to inappropriate use when they are actually justifiable. So far, no significant attention has been paid or analyzed to this practice – which is the motivation for this edition of the symposium. Once a decision on the secret administration of drugs has been made, a pharmacist should seek advice on the suitability of each drug for secret administration. Pharmacists should refer to the Summary of Product Characteristics (SmPC) of the medicinal product(s) concerned and other appropriate reference sources (see “Additional resources for grinding medicinal products”). If a patient is found to be ineffective and unlikely to regain capacity (i.e. The impairment or disruption of mind or brain function is not caused by a temporary or reversible change in mental state), then the decision-making process can continue. At this point, all medications should be reviewed for clinical necessity.
NICE QS85 suggests that this clinical examination of medicinal products can be carried out by the patient`s general practitioner[2]. However, a properly qualified clinical pharmacist would be equally adept at conducting this comprehensive medication review. Covert administration should only be given to people who are unable to consent to treatment Guidelines for the appropriate use of secret administration are well documented in the regulations of the Care Quality Commission (CQC)[5] , the UK regulator for all health and social care providers, and in the National Institute of Health and Care Excellence (NICE) guidelines[6]. England`s Health Technology Assessment Agency. The CQC states: “Where it is agreed that it is in the best interests of a person, the provisions relating to the secret dispensing of medicines must be in accordance with the Mental Capacity Act 2005.”[5] According to the Mental Capacity Act 2005, Guideline SC1 (Handling of Medication in Nursing Homes) states: “Health and social practitioners should not administer medication to a resident without his or her knowledge (secret administration) if the resident is able to make decisions about his or her treatment and care.”[6] The NICE 85 quality standard (NICE QS85; Drug Management in Nursing Homes) also supports this assertion by stating that all adults living in nursing homes who have been found incapable can only receive infiltration medication if a management plan is agreed at a meeting to discuss the patient`s best interests[2].
