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Background and Objectives: This study aimed to explore the experiences and perceptions of nursing home staff and residents of unauthorised covert administration of medication. Prior studies identify that covert medication administration (crushing medication to administer in food or drink) is common in nursing home settings. Still, few recognise that this practice may occur without consultation or clinical authorisation. Design: An exploratory qualitative study was conducted with nursing home staff and residents as part of a more extensive mixed‐methods study on medication omissions and clinical decision‐making. Methods: We conducted a qualitative study using focus groups and semi‐structured interviews across four geographical areas in New Zealand to better understand nursing home staff and residents' experiences and perspectives on covert administration. Semi‐structured interviews took place with 11 Clinical managers/leads and one senior Registered Nurse; role specific focus groups were held with Registered Nurses (n = 6), Health Care Assistants (n = 14), and Residents (n = 12). Data were analysed using thematic analysis. Findings: Participants described covert administration as a practical option if a nursing home resident refused medication but recognised it was a deception that carried ethical and clinical risks, particularly when unauthorised. Participants felt that unauthorised covert administration stemmed from doubts about residents' competence and the competing demands staff face during medication administration. Staff, who typically relied on advice from their pharmacies around which medications were safe to crush, expressed a need for more education. Conclusions and Implications for practice: This study provides evidence that unauthorised covert administration of medications is an ongoing practice, using New Zealand nursing homes as an example. The results emphasise that nursing home staff and residents are aware that this practice carries ethical and clinical risks and requires a certified process to legitimise its authorised form. [ABSTRACT FROM AUTHOR]

Research in care homes has demonstrated that medication management practices in patients with dysphagia and those receiving medicines covertly may be inappropriate, illegal, and potentially cause harm. This paper presents the results of a feasibility study piloting a resident and healthcare professional best practice charter to improve such practices in care home residents with dysphagia. A charter was developed through a multi-professional expert panel, implemented in one care home, and then piloted in 22 homes in England, Wales, and Northern Ireland. A website was setup and developed iteratively to support the process. Care home staff and residents provided initial feedback on the implementation process and on perceived outcomes six months post implementation. A total of 16 (88.9%) out of 18 respondents from nine homes for six months reported a positive response to the charter. More than 80% of responses regarding the implementation process, impact on staff confidence, and perceived usefulness of the charter were positive. Perceived effectiveness and usefulness could, however, be further improved especially the perceived effect on frequency of medication review, which is reliant on external stakeholder involvement. The charter and supporting website were well received with respondents believing that it was useful, staff showing more confidence, and residents having enhanced care. Approaches to enhancing the charter’s effectiveness were identified.

Objectives: Covert medication involves the administration of any pharmacological agent in a disguised form. Despite some evidence that the practice is common, there are no legal guidelines for its use in England and Wales. We attempted to ascertain our current practice against standards for best practice that was devised. Method: Questionnaires were sent to a sample of 62 carers of adults (aged 18 years or over) with learning disabilities (intellectual disabilities). The questionnaires were based on standards set after consultation with a variety of sources. Results: A 94% response rate was achieved from questionnaire returns (n = 58). 16% (n = 9) stated they were administering medications covertly. Of these, 78% (n = 7) were not aware nor had a policy in place for this practice. Seventy-eight per cent (n = 7) had no written record of the patients' mental capacity. For those practising covert administration, most of the managers, General Practitioners (GPs, also known as Family Doctors) and Family members were made aware, but there were poor awareness levels by the pharmacists and the consultant psychiatrist (responsible clinician). The documentation of capacity assessment was poor. Discussion: Various key members of the multidisciplinary team were not made aware of the practice of covert administration. This may imply a deficiency in knowledge base on what constitutes defensible practice and this highlighted education and training needs. Interventions included presentations in a variety of settings to highlight the practice and standards. There is a need for repeating the audit with larger numbers. [ABSTRACT FROM AUTHOR]

Covert administration of medication has always been controversial and has not always been specified in care plans, it should be limited to incapacitated patients where the treatment is necessary and in best interests, or else authorised by mental health legislation or an appropriate court declaration. A lot of nursing and HCA practice that involves putting medication in food or drink may not actually be disguising it from the patient at all. The NMC guidelines do not refer to the Mental Capacity Act and are due for review, meanwhile the Maudsley Prescribing Guidelines are recommended. It is vital that HCAs and APs who administer or assist with medication understand their legal and ethical authority for hiding it, and reviewing the reasons with the wider team. [ABSTRACT FROM AUTHOR]

Any mentally competent adult has the right to give or refuse consent to treatment or nursing intervention. The ethical principle underpinning this free choice is respect for autonomy, and the nurse's professional duty to respect the decision of the patient is enshrined within the NMC's Code of Conduct (NMC, 2008). Capacity is paramount to consent and problems arise in practice when the patient is deemed to lack capacity. In this instance, the provisions of the code of practice of the Mental Capacity Act apply (2005). The aim of this article is to present the issues that arise when patients lack decision-making capacity, especially in relation to older adults with dementia who lack the capacity to consent to medication, as well as the covert administration of medication. In relation to consent and covert administration, the nurse is required to balance respect for the patient's autonomy with their desire to act beneficently and in a non-maleficent manner and emphasis will be given to these underlying ethical principles throughout the article. [ABSTRACT FROM AUTHOR]

Research in care homes has demonstrated that medication management practices in patients with dysphagia and those receiving medicines covertly may be inappropriate, illegal, and potentially cause harm. This paper presents the results of a feasibility study piloting a resident and healthcare professional best practice charter to improve such practices in care home residents with dysphagia. A charter was developed through a multi-professional expert panel, implemented in one care home, and then piloted in 22 homes in England, Wales, and Northern Ireland. A website was setup and developed iteratively to support the process. Care home staff and residents provided initial feedback on the implementation process and on perceived outcomes six months post implementation. A total of 16 (88.9%) out of 18 respondents from nine homes for six months reported a positive response to the charter. More than 80% of responses regarding the implementation process, impact on staff confidence, and perceived usefulness of the charter were positive. Perceived effectiveness and usefulness could, however, be further improved especially the perceived effect on frequency of medication review, which is reliant on external stakeholder involvement. The charter and supporting website were well received with respondents believing that it was useful, staff showing more confidence, and residents having enhanced care. Approaches to enhancing the charter's effectiveness were identified.