Covert administration of medicines has recently hit the news again and in my training I often meet care workers who do not understand what covert administration is and why it is not acceptable. ‘Covert’ administration of medication is disguising the medicine in food, normally by crushing tablets or opening capsules and mixing them with the food to be eaten by the service user.

Care workers who have not been trained on medicines management will often think they are acting in the best interest of the service use, rationalizing that it is better that the person gets the medication than go with out because they do not want to take it. On the surface it appears a reasonable thing to do to them.tablets, capsules,

However, by law consent must be obtained from service users before any treatment or care or help with taking their medicines is given to them. Their decision, whether or not to agree to treatment or care has to be based on adequate information so they can make up their own mind what level of support is appropriate for them.

In theory a service user can agree to treatment and care verbally, in writing or by implying (by co-operating) that they agree. Equally a service user may take away that consent in the same way. Even though verbal consent or consent by implication would be enough evidence in my book nothing beats written consent, it’s always preferable and probably expected in most care agency policies.

Such consent should be recorded in the care plan and the service users signature obtained on the care plan during the care assessment. Written consent stands as a record that discussions have taken place and of the service users choice.

In the context of medication you need to be aware of how consent is managed. You are likely to need the service user to sign for their medication administration; this may be done once at the care assessment stage, each week/month as a new medication administration record is used or each

It is important that information is shared freely with the service user, in an accessible way and in appropriate circumstances. This includes providing patient information leaflets to your service users, and if necessary reading and explaining these to them if they are not able to do this themselves.

In an emergency situation were treatment is necessary to preserve life and the service user cannot make a decision (for example because they are unconscious), the law allows you to provide treatment without their consent, providing you are sure you are always acting in their best interest.

You should also know that if the service user is an adult, consent from relatives is not sufficient on its own to protect you in the event of a challenge, as nobody has the right to give consent on behalf of another adult unless the service user has passed over the power of attorney to another person. In this case the other person can give their consent for you to administer medication

Legally, a competent adult service user can either give or refuse support, even if refusal will be to their detriment. However, you must respect the refusal of consent by a service user just as much as you would their consent. You must make sure that service user has been fully informed and, when necessary, involve another member of the health and social care team. You should make sure that a summary of any such discussion and the decision is documented in the service users records.

Consent to support with the administration of medicines means there must never be any ‘covert’ administration of medication e.g. disguising the medicine in food (unless someone is mentally incapacitated and a multi-disciplinary team deems this to be in the service users best interest).

It is important that the principles governing consent are applied just as vigorously to all forms of care with people who are mentally incapacitated as with a competent adult. When a service user is considered incapable of providing consent, or where the wishes of a mentally incapacitated service user appear contrary to the interests of that person, you may need to involve other people close to them, but respect any previous instructions the service user gave. Covert administration is still a last resort and can only be authorized by a multi-disciplinary team of health professionals.

As you can see gaining consent may not be as straightforward as it first appears. Nonetheless, it is a vital part of caring for people. The reason it is so important is that it is assumed that the service user is the best person to be in control of their care. So any procedure that may affect them can only be given once they have consented to the care and this includes medication.