Disguising medicines in food or drink without the knowledge or consent of the service user is referred to as 'covert medication'.
Covert medication is not the same as 'crushing medication'. Crushing medication may be required if, for example, an individual has a swallowing difficulty or dislikes the taste of a medication, and consents or requests their medications are crushed, in liquid form or mixed with drink or food. However, staff must never crush tablets or open capsules without prior agreement, advice, and clear instructions from the prescriber/pharmacist and without it being recorded as part of a service users care/support plan.
Crushing some medications or opening some capsules may; alter the effect of the medications, cause serious side effects, slow down recovery from illness and prevent the medication from working properly. Mixing some medications with some foods or drinks may also affect the active ingredient of the tablet or capsule.
The service user's prescriber/pharmacist will usually only approve the crushing or opening of capsules where there is no suitable alternative, for example, a liquid, soluble tablet or alternative route of administration. Any decision and instructions from the prescriber/pharmacist must be clearly recorded and documented in the service users care plan and MAR and should include how the medication is to be crushed or mixed with food/drink. For example, using a crushing device only (this should be supplied by the pharmacist or purchased by the service user).
The provider must ensure separate MAR audits are carried out for service users requiring support with crushed and mixed medications. The following points should be checked as part of the audit process to ensure the requirements were in place prior to support being provided and if not, to ensure relevant action is taken to address them:
- Has appropriate advice/support been obtained from GP/Pharmacist and is this documented, signed and dated?
- Is there evidence that the service user has consented to having their medication administered this way?
- If not, has the guidance on the lack of capacity to consent been considered?
- Is the reason why the medication is being supported with/administered in this way clearly identified in the service users care plan?
- Is there a printed MAR in place from the pharmacist? See auditing of a medication administration record (MAR) for further guidance