Giving medicines covertly – the main challenges for providers

Featured article - 13 November 2019
Cathy Cooke, Social care and secure environments medicines management consultant

Head-shot of the author, Cathy Cooke, Social care and secure environments medicines management consultant

Helping people to access the medicines they need safely has been the primary goal of my career as a pharmacist. Starting in community pharmacy, I have worked in a wide variety of roles, including medicines advisor to a UK-wide health and social care provider and hospital pharmacy manager. I was vice chair of the development group for NICE guideline ‘NG67 Managing medicines for adults receiving social care in the community’ and was involved in the development of the SCIE quick guide.

From my conversations with care providers, I know that getting the management of covert medicines right can be a concern for managers and their teams. The main challenges that providers face are:

  • Deciding when refusal to take a medicine becomes important
  • Getting advice on the best way to give a medicine covertly
  • Ensuring that care workers understand the agreed procedure and why it must be followed

When is refusal important?

Individuals have a right to refuse to take a medicine if they wish, providing they understand the consequences of doing so and can make an informed decision. How quickly not taking a medicine can affect a person’s health will depend on the individual and the medicine. Medicines for conditions such as epilepsy, asthma or heart disease are more immediately critical than, say, missing a dose of cream for eczema. Good practice is to inform the prescriber if a person is refusing a critical medicine so that they can advise on what action to take.

What’s the best way to give a medicine covertly?

This will depend on the medicine and the person. The pharmacist who takes part in the multidisciplinary assessment will be able to advise on administration, such as whether a liquid version is available or whether a tablet is safe to crush. If permitted to mix with food, always offer at the start of a meal - mixed in a small amount of food - to ensure the person gets as much of the dose as possible if they don’t eat all of the food.

Following the agreed procedure

It’s important to exactly follow the specified procedure for each medicine to be given covertly as this has been agreed as the safe and effective way to administer it. The procedure must be detailed in the care plan with the review date for assessment of ongoing need.

I believe the quick guide is an essential tool for managers, providing a handy checklist for what steps to take and highlighting the responsibilities of other parties. Additionally, it can be used as a resource for training the team, helping everyone to be confident in giving medicines covertly.

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