Covert administration of medications Essay Example

is noted In Ax's care plan that he has in the past effused to take tablets, following discussion by the nursing team and since being dispensed nurses have administered the tablet concealed within foodstuffs. X is not aware that this is being done, it has however been noted in his drug administration carded that "due to his level of intellectual disability client can neither consent nor refuse treatment".

X has had an excellent response to the medication, with staff seeing a significant decrease In his presenting challenging behavior. No written local policy exists which deals with the administration of medications covertly In this ay. After SIX weeks x was reviewed by the consultant psychiatrist and she recommended that he continue taking the medication for a further six weeks, it was brought to her attention at this point that X was being administered his medication covertly within foodstuffs.

The psychiatrist had to consider recharging his medication for a further six weeks with the knowledge that no efforts have been made to give the medication openly in Its normal tablet form, however following discussion with staff, the medication was recharged as the psychiatrist believed that staff have Ax's best interests in mind and consider the administration of the medication to be essential for his health and well-being and for the safety of others. The author intends to discuss this case outlining the legal, ethical and professional issues it raises for all staff involved.

As a general principle of law, every human being of adult years and sound mind has a right to determine what shall be done with his or her body. The main legal issues that

surround decision making for persons with intellectual disabilities are of capacity and consent. Every adult is presumed to have the capacity, but it is a resumption that can be rebutted. Once persons have reached adult age it is assumed in law that they are capable of making decisions. However, if a person has some form of intellectual disability and it can be demonstrated that they are not capable then different rules apply.

Here a person must be able to understand the nature of the action and its consequences to be able to take a legal decision. Capacity is determined by a test of understanding not wisdom, Law Commission (1995). A person lacks capacity if some impairment or disturbance of mental functioning, such s intellectual disability or dementia renders the person unable to make a decision whether to consent to or refuse treatment, then the law allows medicines to be given in the absence of a valid consent in the person's best interest (House of Lords, 1989).

Kay, Rose and Turnbuckle (1995) have stated that the term profound disability means that the individual will require maximum assistance in most if not all aspects of everyday life, in terms of 24-hour care and supervision, the person may have difficulty in understanding, communicating, eating and drinking, continence and obligation.

In the previous mentioned case due to the clients profound degree of intellectual disability he would be deemed incapable of consenting to the treatment and the medication would have proven to be necessary in his best interest, that is in the reduction of challenging behaviors, which can be objectively Justified by examining behavioral records in his care plan, were

the covert administration malicious then a criminal offence under the Offences Against the Person Act 1861 would be committed.

Tremolo, Beats, and Philipp (2000) conducted a study on the overt administration of medications to patients with dementia in institutions and in the community in the I-J and found that 71% of respondents working in residential, nursing, and inpatient units questioned, reported that medications were sometimes given in a covert way. Kirkwood and Engaged (2005) conducted a similar study in Norwegian nursing home units and special care units for people with dementia, their findings saw that 43% of wards within the study reported that at least one patient was sometimes given drugs covertly.

Both studies reported that covet administration as often done secretly and without discussion, probably for fear of professional retribution, Kirkwood and Engaged (2005) concluded that even if, as most careers and some authorities thought, covert administration can be Justified, the poor recording and secrecy surrounding the practice was a huge cause of concern. No opportunity for formal discussion had taken place between the multidisciplinary team informing them of the issues surrounding the administration of the antispasmodic drug in the case of X and it is not documented if any other methods of administering the medication were tried.

Best practice guidelines are available to assist those administering medications covertly from the Mental Welfare Commission for Scotland (2006) in the form of the "Covert Medication Pathway', this would be essential in this case. Tremolo, Beck and Paton (2001) state that the opportunity for legal redress is a key element of the UK Human Rights Act 1998, the completion of this care pathway legal redress is

possible. The Law Commission (1995) has the view that treatment should be made available to severely incapacitated clients Judged according to their best interests and administered in the least restrictive manner.

In exceptional circumstances this may require the administration of medications within foodstuffs, when the client is not aware that that is being done. I would advocate that the Mental Health Act (2001), Article 60, a & b and the Adults with Incapacity Act (Scotland) 2000, (HOMOS, 2000) be considered in this case, a treatment plan should be drawn up between the senior nurse or manager on duty, general practitioner and consultant psychiatrist and reasons for the plan should be discussed by the multidisciplinary team and a record of the discussion made.

This helps to impose a duty of care on those who administer the medication. In the case of X, he was unable to consent to his treatment due to his intellectual disability and on consideration of his case the prescribing consultant agreed that the covert administration of his medication was in his best interest, however, it is this author view that some formal discussion should have taken place with involvement from all members of the multidisciplinary team before the medication was administered in such a way, this would have ensured that the intervention was objectively Justified.

Ethical Issues: Persons with intellectual disabilities are increasingly being encouraged to take an more active role in decisions about their psychological and medical treatment, raising complex questions concerning their ability to consent. Informed consent is a problem for people with intellectual disabilities as they are seen as being less competent to provide consent than the general population.

A person with an intellectual disability will have difficulty providing informed consent throughout their lifetime.

The Adults with Incapacity (Scotland) Act 2000 recognizes that being born with an intellectual disability may limit a person's ability to act or make some or all decisions for themselves, depending on the severity of their condition. This problem permeates many other fields, such as work with older people. However, among older people problems with informed consent may be limited to particular life stages as discussed by Wong, Upon, and Huh', (2005) who posit that ethical, legal, and clinical considerations become more complex when the mental incapacity is temporary and when the covert medication actually serves to restore autonomy.

Xa client with profound intellectual disability had presented with severe aggression towards peers and staff and self-injury which required him to be prescribed an atypical antispasmodic drug as recommended by the consultant psychiatrist. Infield and Tongue (1995) while developing their "Developmental Behavior Checklist" found that behavioral and emotional difficulties requiring some form of medical intervention have consistently shown to be two to three times more common in persons with intellectual disabilities than in the rest of the population.

The medication was given to X covertly concealed within foodstuffs for the duration of his treatment and was only brought to the psychiatrist's attention at a planned review after six weeks. Nurses administering the covert medication to X noted that "due to his level of intellectual disability client can either consent nor refuse treatment". The common argument of those who support the use of covert treatment is that it is the least distressing method of treating someone who will otherwise come to harm.