Covert medication administration, also known as surreptitious medication administration or medication without consent, refers to the practice of administering medication to a person without their knowledge or consent. This can take place in a variety of settings, including hospitals, nursing homes, and even at home by a caregiver or family member. Covert medication administration is generally considered to be unethical and is often illegal, as it violates a person's autonomy and the principle of informed consent.
There are a few situations in which covert medication administration may be justified, such as in cases of severe mental illness where the person lacks capacity to make decisions about their own treatment. However, even in these cases, the use of covert medication should be carefully considered and only used as a last resort after other options have been exhausted. In addition, the person's family or legal guardian should be involved in the decision-making process, and the person should be informed about the medication as soon as possible, once they regain capacity.
One of the main ethical concerns with covert medication administration is that it undermines a person's autonomy and dignity. Every individual has the right to make decisions about their own healthcare, and covert medication administration denies them that right. It also violates the principle of informed consent, which requires that a person be fully informed about their treatment options and give their consent before any medical procedure is performed.
Another concern with covert medication administration is that it can lead to a lack of trust between the healthcare provider and the patient. When a person discovers that they have been given medication without their knowledge or consent, they may feel betrayed and resentful towards their healthcare provider. This can damage the therapeutic relationship and make it more difficult for the healthcare provider to effectively treat the patient.
In addition to being unethical, covert medication administration can also be illegal. Depending on the specific circumstances and the jurisdiction, it may be considered a form of assault or battery. It is also considered to be a form of abuse in cases where it is done by a caregiver or family member, and can result in criminal charges.
Overall, covert medication administration is a serious issue that violates a person's autonomy and dignity, and should be avoided whenever possible. If it is deemed necessary, it should only be used as a last resort and should involve the person's family or legal guardian, as well as careful consideration of the potential risks and benefits.
Covert administration of medicines in care homes
Psychiatric Services, 56, 481—483. However, once a decision has been made to covertly administer a particular medicine following an assessment of the capacity of the resident to make a decision regarding their medicines and a best interests meeting , it is also important to consider and plan how the medicine can be covertly administered, whether it is safe to do so and to ensure that need for continued covert administration is regularly reviewed as capacity can fluctuate over time. A contact hour is 60 minutes of instruction. This was due to feelings of intimidation by the prescriber and an inability to effectively communicate their concerns. However, if the outcome of the assessment is not entirely clear, an appropriately trained healthcare professional e. Your CPD module results are stored against your account here at The Pharmaceutical Journal. When covert administration of medicines is being considered, there should be a 'best interests' meeting.
The Covert Administration of Medications: Legal and Ethical Complexities for Health Care Professionals
Metabolism and elimination In healthy male volunteers, about 82% of a 0. Drug Interactions No specific pharmacokinetic or other formal drug interaction studies were conducted. The latest conversion seen was at 90 minutes after the start of the infusion. Adults who live in care homes who may not be able to make decisions about their treatment and care may need to be given their medicines without them knowing known as 'covert administration' , for example hidden in their food or drink. Both Initially 2 12 33 45 48 At 24 hours 2 12 28 42 43 Atrial flutter Initially 0 14 30 58 55 At 24 hours 0 14 30 58 50 Atrial fibrillation Initially 5 10 35 32 40 At 24 hours 5 10 25 26 35 PERCENT OF PATIENTS WHO CONVERTED Second Trial Ibutilide Placebo 1. Patients had had their arrhythmias for 3 hours to 90 days, were anticoagulated for at least 2 weeks if atrial fibrillation was present more than 3 days, had serum potassium of at least 4.
Management of polymorphic ventricular tachycardia includes discontinuation of ibutilide, correction of electrolyte abnormalities, especially potassium and magnesium, and overdrive cardiac pacing, electrical cardioversion, or defibrillation. You cannot treat someone as lacking capacity for this reason. Mental capacity assessments Before consideration is given to covert administration of medicines to a patient, a mental capacity assessment, in line with the Mental Capacity Act 2005 , must be undertaken. Holtzclaw, University of Oklahoma College of Nursing. Skilled personnel and proper equipment see Dilution Corvert Injection may be administered undiluted or diluted in 50 mL of diluent.
(PDF) Covert administration of medication to older adults: a review of the literature and published studies
The pharmacokinetics of ibutilide are highly variable among subjects. Another adverse reaction that may be associated with the administration of Corvert was nausea, which occurred with a frequency greater than 1% more in ibutilide-treated patients than those treated with placebo. Covert administration of medicines: Disguising medicine in food and drink. Your staff must read, understand and follow the policy. Ibutilide is also cleared rapidly and highly distributed in patients being treated for atrial flutter or atrial fibrillation. This is particularly important for people with fluctuating capacity.
Covert Medication Administration: The Practice of Hiding Medications in Long
For example, if a patient has not been taking their antihypertensive medication for a fortnight but their recent blood pressure readings are within acceptable parameters, it may be more appropriate to continue without medication and for this decision to be reviewed at defined intervals. Pediatric Use Clinical trials with Corvert in patients with atrial fibrillation and atrial flutter did not include anyone under the age of 18. The practice of covertly administering medications to patients without their consent is often discussed in the framework of legal questions around the right of patients to consent and refuse medical treatment. Some medicines can become ineffective when mixed with certain foods or drink. Discuss recommendations for practice with regard to the CoMAd in long-term care settings. I am being told by the care coordinator that this practice is considered unethical and does not follow best practices.
Covert Medications: Act of Compassion or Conspiracy of Silence?
GP or specialist nurse should be involved. The resident, who has been deemed competent, would sometimes refuse to take the medications the physician prescribed; therefore, the physician asked the RNs to tell the resident it was something like a blood pressure pill that he would be willing to take, and the RN staff complied. You must only use the plan when the person lacks capacity. The decision-making process must be easy to follow and clearly documented. Aging Clinical and Experimental Research, 16, 326—330. Laboratory Test Interactions None known.
The practice is not uncommon in several groups of mentally incapacitated patients. Twenty-four hour responses were similar. About two thirds had cardiovascular symptoms, and the majority of patients had left atrial enlargement, decreased left ventricular ejection fraction, a history of valvular disease, or previous history of atrial fibrillation or flutter. If there is no way to establish the potential effect that the medicine is having, discuss this with the prescriber. Or it could increase any adverse effects due to the whole dose being released too quickly. Reynolds Center of Geriatric Nursing Excellence, University of Oklahoma, and Dr.
Other reported clinical experience has not identified differences in responses between the elderly and younger patients. All participants are required by the accreditation agency to attest to the time spent completing the activity. This essay will look at the main principles supporting supplementary prescribing, the clinical management plan, the partnership and the implementation of supplementary prescribing. Service providers care homes ensure that if a decision is taken to covertly administer medicine to an adult care home resident, then a management plan is also agreed and recorded after a best interests meeting. As the population in the United States gets older, more people suffer from dementia, which often causes neuropsychiatric symptoms such as agitation and paranoia. In long-term follow-up, approximately 40% of all patients remained recurrence free, usually with chronic prophylactic treatment, 400 to 500 days after acute treatment, regardless of the method of conversion. However, this practice also raises significant questions surrounding the professional duties and obligations of health care professionals as it relates to the decision-making process of whether to engage in the covert administration of medications.
Point-counterpoint: Is it ethical to give drugs covertly to people with dementia? Each milliliter of Corvert Injection contains 0. Ibutilide was equally effective in patients below and above 65 years of age and in men and women. Longer monitoring is required if any arrhythmic activity is noted. Reynolds Center of Geriatric Nursing Excellence, University of Oklahoma, and Dr. Voltage clamp studies indicate that Corvert, at nanomolar concentrations, delays repolarization by activation of a slow, inward current predominantly sodium , rather than by blocking outward potassium currents, which is the mechanism by which most other class III antiarrhythmics act. You should also consider alternative methods of administration.