Covert administration is the term used when medicines are administered in a disguised format, e.g. in food or drink without the knowledge or consent of the person receiving them. If the resident is aware that you are disguising their medication in food (e.g. to mask the taste), then this is not covert administration.
Care home staff should not administer medicines (including supplements such as oral nutrition supplements) to a resident without their knowledge if the resident has capacity to make decisions about their treatment and care. Every person has the right to refuse their medication, even if that refusal appears ill-judged to staff who are caring for them.
The MOCH Team have produced a Covert Medication Best Practice guide to support our homes when considering covert administration.
Please also see the ‘Covert Medication Flow Chart’ which can be printed and kept to hand to support decision making.
A resident’s capacity to make decisions about their care and treatment may vary and it is essential that a regular review of their capacity is carried out.
The process to administer covertly should include holding a best interest meeting involving care home staff, the prescriber of the medicines(s) and family member or advocate. The issue of covert administration and any discussions/agreements about it should be recorded in the resident’s care plan including the names of all parties involved and each medication the decision applies to.
Covert administration of medicines should only be necessary and take place in exceptional circumstances. An appropriate written process must be followed to protect both the resident who is receiving that medicines(s) and the care home staff involved in administering the medicines.
It is important to remember that capacity may fluctuate and regular assessments by the clinical team are necessary. Initially, the treatment plan should normally be subject to weekly reviews. If the requirement for covert medication continues, a full review must take place, at least every three months.