Nurse fears over secret medication

Drugs can be given to patients without their knowledge

Nurses have challenged guidance over when they can hide patients' medication in food or drink.

The regulatory body, the United Kingdom Central Council for nursing, midwifery and health visiting, last year said drugs could be given covertly if it was in the patient's best interests - though the practice should not be routine.

These drugs are administered to meet the needs of hard-pressed nursing staff, who often see themselves as babysitters

Chris Barber

But nurses attending the Royal College of Nursing's annual congress in Harrogate described the guidance as "woolly".

They called on the UKCC's replacement - the Nursing and Midwifery Council - to look at the issue again.

Nurses at the conference said they were concerned hiding drugs was not always in the best interests of patients - and that it could be done instead for the convenience of staff.

Chemical cosh

Groups such as Age Concern and the Alzheimer's Society have also expressed concerns about drugs being used as a "chemical cosh".

How often nurses hide medicine is unclear, but the author of the UKCC's position statement, Joe Nichols said a small survey of nursing homes had found 75% of staff had given medicines covertly.

In addition to the guidance on when covert medication is appropriate being developed by the UKCC/NMC, the Lord Chancellor's department is also looking at the issue.

Alan Crump, from the RCN's mental health forum said the term "in the patient's best interest" was often used as a "catch-all term to cover over important ethical issues".

He added: "The UKCC statement has done the same."

He said the best interest "loophole" could be exploited and abused by some.

LSD

Chris Barber, from the RCN's ethics forum said in the 60's drugs such as LSD were given to unsuspecting psychiatric patients.

And he said that, according to Liberal Democrat health spokesman Paul Burstow, "mind-melting drugs" were still being routinely administered covertly.

Mr Barber said: "These drugs are also administered to meet the needs of hard-pressed nursing staff, who often see themselves as babysitters.

"The UKCC said this could be justified. However, what might be justified may not necessarily be right.

"I demand that the NMC goes back and looks at this issue again."

But some nurses defended the practice of hiding medication.

Prozac sandwich

Lisa Crooks from West Somerset told the conference how, as a student four years ago, she helped administer a "Prozac sandwich" to a confused 82-year-old woman.

"It's not a drug known as a life-saving medication. But it saved the woman from undergoing ECT [electro convulsive therapy], which probably would have killed her."

The NMC's Joe Nichols defended his document, which he stressed was not finished guidance, and said it had been drafted to try to help nurses cope with difficult situations.

There is set to be six months of further consultation on the guidance.

Helen Caulfield, policy advisor for the RCN, said the organisation did not have a policy on covert administration, but added: "There's a great deal of confusion about what counts as best interest."