Covert administration and altered medicines

Covert administration is giving a medicine without the person's knowledge or consent, for example hiding tablets in food or drink, administering via a feeding tube without the person knowing, or applying a patch without their awareness.

Covert administration is not a routine care decision. It may be considered only when the person refuses, lacks capacity to make that medicines decision, and the medicine is necessary for their health or welfare. It must be the least restrictive option once other approaches have been tried.

Before covert administration can happen

• Capacity: assess the person for capacity about the specific decision to give the medicine covertly.
• Alternatives: investigate why the person refuses and whether a different formulation, timing or technique would work.
• Best interests: follow a best-interests process involving the prescriber, pharmacist, care staff and family or advocate as appropriate.
• Medicine-specific decision: decide on each medicine individually; a previous or existing covert plan does not automatically apply to all medicines.
• Authorisation: document clear authorisation and instructions in the care plan.
• Pharmaceutical advice: obtain pharmacy advice on whether the medicine can safely be crushed, opened, mixed or given in another altered form.
• Review: use covert administration for the shortest reasonable time and review it regularly.

Covert administration is a formal best-interests process, not a way to get a difficult medicines round finished.