A Report on Covert Administration of Medication in Nursing Practice

This report delves into the practice of covert medication administration within nursing, addressing its complexities and implications. It begins with an introduction to pharmacology and the role of nurses in medication management, highlighting the significance of ethical considerations. The main body of the report explores covert administration, which involves administering medication in a disguised form, such as mixing it in food or drinks, without the patient's explicit knowledge or consent. It emphasizes the legal and ethical aspects, particularly in the UK, where the Mental Capacity Act 2005 plays a crucial role, outlining the rights of individuals and the necessity of considering their capacity to make decisions. The report discusses the legal and pharmaceutical issues that must be considered when administering medications covertly, including the National Institute for Health and Care Excellence (NICE) and PrescQIPP guidelines. It also provides a detailed pathway for covert medication administration, encompassing mental capacity assessment, best interest decisions, management planning, documentation, and regular reviews. The report underscores the importance of a multidisciplinary approach, involving healthcare professionals, family members, and advocates, while emphasizing the need for transparency, inclusivity, and adherence to the patient's best interests. The report concludes by reiterating the significance of covert medication administration as a practice and highlights the need for careful consideration of legal, ethical and pharmaceutical factors.

PHARMACOLOGY FOR NURSES

Contents
INTRODUCTION.....................................................................................................................................3
MAIN BODY.............................................................................................................................................3
a) Discuss the practice of covert administration of medication in nursing...............................................3
b) Legal and pharmaceutical issues that should be considered when administering medicines covertly. 7
Legal issues.........................................................................................................................................7
Pharmaceutical issues..........................................................................................................................9
CONCLUSION........................................................................................................................................10
REFERENCES........................................................................................................................................11

INTRODUCTION
Nursing is one of the necessary zone for treatment of the people and administration of
someone health & protection of people life using kind of adrenaline. Also, in nursery where use
of pharmaceutical is very pro longed along with carry out legal practice to remove its side effects
to the human being. In nursing, practices such as using of the medication and its ethical usage
plays vital role in conduction of treatment and also ensuring its correct applicability in terms of
medication transformation for future benefits of a people (Adams, & Urban, 2015) Covert
administration of medication is one major problems associated to testing and administering
medication to gather its right usage. In this practices, medicines are being administered in the
disguised format such as mixing in the food, drinks or any other using stuff.
This report will light on Discuss the practice of covert administration of medication in
nursing and legal as well as pharmaceutical issues that should be considered when administering
medicines covertly. Also, report will also have discussion on legal and pharmaceutical issues,
when practising covert administration of the medicose. Through this report, an empowering
message will be passed to society to carry out its active participation on a dominant stage. Also,
certain legislation & regulation will be considers in this regards to find correct discussion on
these issues.
MAIN BODY
a) Discuss the practice of covert administration of medication in nursing
Pharmacology is a branch of biology concerned with a study of the drug or medication
action, where a drugs have to be defined in broad manner as like any manmade, natural or kind
of a endogenous which exerts a biochemical or physiological effects on the cell, tissue, organs or
organisms. This kind of study is being focus on studying use of a medicos along with put lights
on a concluding results in given time period. This was noticed that use of medicose by the nurses
is matter of serious concern and there are various cases have been founds, which revealed on
covert administration of medication to people, without knowledge or consent of the person.
Covert administration happens when medicines are being administered in a disguised format.
The medicines can be applied in hidden food, drink or through a feeding tube without knowledge
or consent of a person receiving it. In that condition, person is completely unaware about this

whole and nurses injects this to patient to check or test dose of the medicines. As a result, person
is unknowingly injects the medicines. Moreover, every person has given right to refuses
medicine, if it suits patient or person interest who is injecting it. In UK, covert administration is
mandatory to be practiced or necessary:
 When the person is actively refuses that medicine and which is necessary to be applicable
for the treatment,
 That person is administered not for having the capacity to makes out clear understanding
of the consequences of its own medication refusal. Such capacity is implemented by the
mental capacity act, 2005.
 Medicine is deemed to be an essential to a person well-being and well-being.
Covert administration should be last resort. Nurses have to pursue out reasonable efforts to
gives out medicines in the normal manner. In order to protect health and threat to the human
being, hence there are several other methods of an administration such as use of liquid rather
than solid (Papadopoulou and et. al., 2017). This is why, because liquid dissolves any powder
based drugs in the stomach and due to which threats for its impact is also not that much severe
and serious. To have control on covert administration, there are various laws & regulation that
has been executed to control out the impact of the covert administration. Before taking practices
as part of serious concern, nurses and health professionals have to takes out decisions and action
against key principles under mental capacity act, 2005 which is as follows:
 Every adult have right to makes out his or her decision on taking of any medicose,
whether it is beneficial for person or not. But for covert administration, approval of
person family must be taken, before injecting medication in veins or mixing
medicines in food or drinks,
 During covert administration, person is not to be treated as unable to makes a
complete decision unless of all practicable steps to help them do so have been taken
without the success,
 Nurses must not be treated person to takes out decision merely, because he or she
makes out an unwise decision. Person have complete right to makes out decision that
other might regards an unwise.

 Person to whom medicine will be injected must be explains on benefits of that
medicose or if in case person not agrees approval of the family member’s would be
taken to do entire application of covert administration at-least with purpose of
someone’s benefits.
Before considers practices of the covert administration, nurses is required to have
knowledge on general principles of the covert administration. In this practices, human right law
is the primary principle that helps to determine decision to proceed (Alotaibi & Chan, 2019)
During this, right to respect someone’s life means that an individuals are being capable of
making an effective decision have a right to accept or refuse medical treatment, even where a
refusal might be lead to detrimental outcomes. Covert application of the medicines cannot be
given to someone who are capable to have decision on medical treatments. Administering
medicines have to be use food or drink can alter its own properties and effects. They could
become unsuitable or ineffective. Always take advice from a healthcare professional to make
sure medicines are safe and effective.
Cover administration is being recognised as the most appropriate option the following
principles should be seen as good practices.
 Last resort: Covert administration is one of less restrictive practice, either all options
have been tried,
 Medication specific: In this, need will be identified for each medication prescribed,
 Time limited: This will be used for short possible time as much as possible,
 Regularly reviewed: Continues need for covert administration must be regularly
reviewed within specified time scales as should the person’s capacity to consent,
 Transparent: In this, decision making process can easy to follow and clearly
documented,
 Inclusive: Decision making process must be involve an effective discussion &
consultation with appropriate advocating for the patient. It must not be a decision taken
alone,
 Best interest: In this all kinds of decisions will be taken as personal consideration best
interest with due consideration to the holistic impact on the person’s health and well-
being.

In the nursing, covert practice is meant to inject medicine to person, in case he or she are not
agreed to take that medicine. In UK, there are several unethical practices such as administration
even without approval of person’s family member. Along with this, there are several legal and
ethical issues has been found such as low of quality of food or liquid for health purpose. During
covert administration, an effective pathway or process has been structured with use of its,
medication will would be given to patients. This pathway for the medication is comprises of four
different stages which is as follows:
Mental capacity assessment: Before convert administration is to be considered as an
option, decision making and action plan is carried out as per mental capacity act, 2005 which
will be tested in response to five key principles set out as below. The above key statutory
principles in assessing capacity are as follows:
 A person must be assumed who have capacity to led an effective decision unless it is
established,
 A person is not to be treated as unable to led decision unless all practicable steps to help
him or her to do so have been taken without success.
 A person to whom medicose has been inject either approval will be taken from that
person or approval of a family would gather.
 Also, decision must be taken in best interest of the person.
 A person must have less restrictive option.
Using these principles will be given to checking mental checking capability and ability to handle
medication pressure. This kind of practices is based on consent of focused person.
Best interest decision: This pathway process of covert medication have involves multi-
disciplinary approach involves consists of the GP, concern about nurse or care worker, lasting
power of an attorney, family and also friends. In this kind of practice, skill and competencies of
ta person will be taken into consideration (Lim & Honey, 2017) Once let medication review
would be done, a combined meeting on the patient’s best interests would be revealed to his or her
family to taken their approval also. If patient will undertakes power of attorney for health &
welfare, that person will be consulted to takes about all kind treatment decisions. A patient’s next
of kin may be invited to this meeting or, if the patient has no representatives who wish to attend,
an independent mental capacity advocate (IMCA) should be invited to represent the patient.

Management plan and documentation: In this first step of pathway will be take care, in
which mental capacity of the person have been undertaken to takes on decision making about full
medication. This step concern mainly concern about who, where, how, when, what and why
when initiates decision making on medication to specific patient. Medication will have given in
liquid form with missing in juices, dose is planned on per day basis and also for entire weak.
Also, Covert administration must be undertaken after report from health centre to decide quantity
and quality of medication will be given.
Figure 1 Covert administration pathway
This is also disclosed that medication have to be done by nurse who are qualified along
with having expertise to given dose of medicine to patient. During this practice, a clear checklist

is prepared of per day covert administration and also for how much time, this would be
continuous. This type of formal will be led expertise professional nurses.
During this, an effective management plan have to be prepares and then administered
safely. A complete review will be undertaken to maintain its right value for the medication.
Reviews: In this stage, a specific timeframe will be made for review which can be either
daily, weekly, quarterly or yearly basis. In this, full command will be given to evaluate each and
every stage of management plan. During this, change in medicine such as alters in dose, forms
such as liquid or water is part of an entire process (Hammad and et. al., 2015) Also, complete
review have an inclusion of the assessment, whether covert administration of a medicines is less
restrictive option or not. After, this, outcomes of the complete review is suitable to communicate
with head health practitioner and senior nurse to maintain information at a one common place.
b) Legal and pharmaceutical issues that should be considered when administering medicines
covertly
Covert administration of medicines can be said to be a complex issue which usually
comprises of disguise of administration of medicine in the form of drink or food to a patient that
lacks the basic capacity to give consent to treatment. Covert administration is not to be
interchangeably used with disguise of administration of a medicine as found to be against the

intentions and desires of a competent patient. This is so because this leads to civil wrong of
trespass to an individual or a tort.
There are certain legal and pharmaceutical issues which need to be constantly taken into
consideration before covert provision of medicines to people. These are described in detailed
manner below:-
Legal issues
National Institute for Health and Care Excellence (NICE) and PrescQIPP have proposed
some guidance upon issues that must be taken into account while covertly giving the medicines.
In this regard, The Nursing and Midwifery Council (NMC) has also included the below
mentioned statement in relation with covertly administration or disguise of medicines within
their standard for medicinal management:
“The registrant would need to be sure what they are doing is in the best interests of the patient,
and that they are accountable for this decision”
Further, CQC has also referred to covert administration within Regulation 12 of the
regulations stipulated for manager as well as service provider, as follows:
“When it is agreed to be in a person's best interests, the arrangements for giving medicines
covertly must be in accordance with the Mental Capacity Act 2005.”
The guiding notes and information provided by NICE as well as PrescQIPP have laid out
a detailed description of legal issues which must be taken into account duly. Even though it is
proposed as a guidance note in relation to treatment rendered within care home, the issues
associated with law and statute that must be taken into due consideration are found to be
identical within another healthcare setting (Doggrell and et. al., 2015) This guiding note has
further also been reinstated by a ruling of court taken in recent times emerging from the trials of
AG v BMBC & SNH [2016]. The guidance that is provided therein lays out the following
mentioned details which clearly specifies the actions that must take place before the covert
administration of medication occurs:-

 It must be taken into account that the user do not possess the capacity to undertake any
kind of decisions or give any type of consent for treatment aligned with the Mental
Capacity Act 2005.
 The cure given must be deemed essential and belong to one of the most lowly restrictive
options available for the patient.
 A meeting for “best interests” must occur whereby the most optimum form of action for
the patient should be decided upon. PrescQIPP has further established a checklist from
the Mental Capacity Act (MCA) of the year 2005 that must be taken into due
consideration and excessive guidance is available from British Psychological Society in
relation to the conduction of such a meeting.
Pharmaceutical issues
The risks of degrading the medicine within food/drink versus the risks of not giving the
medicine at all should be constantly taken into consideration. When any type of medication is
mixed with a drink or food, recommendation is such that it should be added to first mouthful of
food so that receipt of full dose can be taken. In this regard, certain pharmaceutical issues must
be taken into consideration before giving medicine covertly. Further, it is essential that
acceptability to patient, absorption of medicine when administered within drink and food,
incompatibility of medication with food & beverage.

CONCLUSION
From the above report, it is concluded that covert administration is the complex issues
which is mainly implements on patients. Nurses who perform this work must have legal and
ethical skill with help of which an effective practices will be conducted. Hence, vital is to have
formal kind of a regulation with help of which a progressive working will be undertaken in
health care sector. This is also concluded that, covert is the part of a complex issues which can be
proved wrong in case, if planned wrongly and also with lack of understanding. Along with this,
initiation of a management plan is the corrective tool to have corrective check on each and every
activity of the covert administration. Also, this has been proved necessary to create a complete
pathway with help of which decision making will be taken changes in med and time frame for it.

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