What is Covert Medication?
Covert medication is when medicines are administered hidden in food or drink without the knowledge of the person receiving them. This may be necessary when a person lacks capacity to consent to medication and consistently refuses to take essential medicines.
Legal Warning
Covert administration should only ever be used when the person lacks capacity to make decisions about medication AND it is in their best interests. Giving medication covertly to someone with capacity is assault. Always follow proper legal processes.
Legal Framework
Covert medication must comply with the Mental Capacity Act 2005:
- Person must lack capacity to decide about medication
- All practicable steps to help them decide must have been taken
- Decision must be in their best interests
- Least restrictive option must be used
Required Documentation
Mental Capacity Assessment
A formal capacity assessment must be documented showing the person cannot:
- Understand information about the medication
- Retain the information long enough to decide
- Weigh up pros and cons of taking/not taking medication
- Communicate their decision
Best Interests Decision
A best interests meeting must be held involving:
- Prescribing GP or consultant
- Care home manager or senior carer
- Family members or advocates
- Pharmacist (ideally)
- Any other relevant professionals
Capacity assessment
Specific to medication decisions, completed by appropriate professional
Best interests record
Minutes of meeting, who attended, decision reached and rationale
GP written agreement
Prescriber must agree in writing to covert administration
Pharmacist consultation
Advice on which medicines can be safely crushed/disguised
Family consultation
Record of discussion with family (they cannot veto but should be consulted)
Care plan update
Specific care plan for covert administration with clear instructions
Review date
Regular review schedule (typically 3-6 monthly)
Practical Considerations
Pharmacist Advice
Always consult the pharmacist before covert administration to confirm:
- Medication can be crushed/opened (some cannot)
- Appropriate vehicle (food/drink) to use
- Any interaction with food
- Stability when mixed
- Alternative formulations available
Administration Process
- Prepare medication away from the person
- Use appropriate masking food/drink
- Ensure whole dose is consumed
- Do not mix multiple medications together
- Document administration as usual on MAR
Not All Medications Can Be Given Covertly
Slow-release tablets, enteric-coated tablets, and some capsules cannot be crushed. Pharmacist advice is essential. Alternative formulations (liquids, dispersible tablets) may be available.
Review and Monitoring
Covert medication decisions must be regularly reviewed:
- Has capacity changed? Reassess regularly
- Is medication still necessary?
- Could less restrictive alternatives now work?
- Are there side effects affecting quality of life?
- Is the medication still in the person's best interests?
What Cannot Be Given Covertly
- Medication to someone with capacity
- Medication solely for staff convenience or behaviour management
- Medication not prescribed for the person
- Medication without proper documentation
CQC Expectations
CQC expects to see:
- Clear covert medication policy
- Individual documentation for each case
- Evidence of multi-disciplinary involvement
- Regular reviews
- Staff training on MCA and covert administration
Related Medication Guides
Covert Medication Documentation
Revitaco provides structured templates for capacity assessments, best interests decisions, and covert medication care plans with automatic review reminders.
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