An audit on covert administration of medications to adults with learning disabilities

Abstract

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.

Keywords:

• Learning disability
• Intellectual disability
• Covert administration
• Medication

Additional information

Notes on contributors

Neel Halder

Correspondence to: N. Halder, Alpha Hospital, Buller Street, Bury BL82BS, UK. Email: [email protected]