Reflection about the use of Covert medication in learning disability nursing
Covert administration of medicine is the disguising of medication on food and drink. The practice of administering covert medication is controversial. In mentally capable patients it is a breach of autonomy and likely to constitute assault. For people who lack capacity (either permanently or temporarily), the question is whether the best interest of the individual is justification enough for covert practices.
Within my practice area, there is a client who occasionally gets his medication covertly. When client needs 'as prescribed ' Lorazepam and Haliperidol it is offered as oral medication in first instance, but if this is refused, in exceptional instances, to prevent any increases in aggression it may be placed in clients food or drink.
AnalysisWithin this situation it is good that giving covert medication will help maintain client and staffs ' safety and prevents an increase in aggression. It also reduces the risk of the use of restraint and I.M medication. It is good practice that the use of covert medication is discussed with the multi-disciplinary team, which it has and has got approval from the psychiatrist. A protocol is put in place and it is all documented. There are also legal guidelines as client is detained under the Mental Health Act with a Compulsory Treatment Order and is under Adults with Incapacity.
It is still hard to agree whether this is ethically right, as although the situation is for the clients best interest and follows guidelines, it is still going against someone 's human rights to autonomy. There could also be an issue between staff as to what constitutes an 'exceptional instance ', staff might interpret this differently and a concern would be that if the practice is condoned in a few exceptional cases, as in an emergency, this could lead to a rise in the abuse of practice.
EvaluationThe NMC has produced advice on the administration of covert medication, saying that as a general principle, by disguising medication in food or drink,
Within my practice area, there is a client who occasionally gets his medication covertly. When client needs 'as prescribed ' Lorazepam and Haliperidol it is offered as oral medication in first instance, but if this is refused, in exceptional instances, to prevent any increases in aggression it may be placed in clients food or drink.
AnalysisWithin this situation it is good that giving covert medication will help maintain client and staffs ' safety and prevents an increase in aggression. It also reduces the risk of the use of restraint and I.M medication. It is good practice that the use of covert medication is discussed with the multi-disciplinary team, which it has and has got approval from the psychiatrist. A protocol is put in place and it is all documented. There are also legal guidelines as client is detained under the Mental Health Act with a Compulsory Treatment Order and is under Adults with Incapacity.
It is still hard to agree whether this is ethically right, as although the situation is for the clients best interest and follows guidelines, it is still going against someone 's human rights to autonomy. There could also be an issue between staff as to what constitutes an 'exceptional instance ', staff might interpret this differently and a concern would be that if the practice is condoned in a few exceptional cases, as in an emergency, this could lead to a rise in the abuse of practice.
EvaluationThe NMC has produced advice on the administration of covert medication, saying that as a general principle, by disguising medication in food or drink,
References: MC (2007) Covert administration of medicines - disguising medicine in food and drink. A-Z Advice.NMCWelsh, S & Deahl, M. (2002) Covert medication - ever ethically justifiable? Psychiatric Bulletin 26: 123-126