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Wednesday, 5 September, 2001, 06:21 GMT 07:21 UK
Rules on 'hidden' medication
Some patients are given pills in food or drinks
Some patients are given pills in food or drinks
The nurses' governing body has approved controversial guidelines on when patients can be given medication "hidden" in their food or drink.

Covert medication is given when a patient is unable to consent because they cannot understand what they are being asked, and doctors and nurses think their condition would be improved with medication.

Campaigners for the elderly have criticised the move, saying giving "secret" medication to patients "cannot be condoned".

But ahead of the UKCC's discussion of the issue on Wednesday, president Alison Norman said publishing guidelines was important, as it would bring the "complex" issue out into the open and thus reassure both patients and medical staff."

She told BBC Radio 4's Today programme bringing the practice out into the open should remove the suspicion that patients were sometimes given covert medication for the convenience of staff, rather than their own needs.

It is a denial of people with dementia's independence and dignity to give them medication without their knowledge

Harry Cayton,
Alzheimer's Society
The new guidance will cover children, people with dementia in care homes and those with learning disabilities.

Patients detained under the Mental Health Act, would also be covered by the UKCC guidelines - where the treatment in question does not relate to their mental illness.

The UKCC says patients should be presumed to have the mental capacity to consent or refuse treatment, unless they:

  • Are unable to take in and retain information
  • Are unable to believe that information
  • Are unable to "weigh-up" the information as part of a decision-making process.

It stresses that where patients can make a decision, refusal of treatment should be respected.

Covert medication should be seen as an emergency procedure, rather than routine, and nurses should talk to other members of staff and patients relatives and carers before going ahead, the UKCC said.

And staff should check with their employers' legal advisors, they said.

Studies have suggested that around 70% of staff working with vulnerable patients have faced the dilemma of whether they should give medication covertly.

Almost all felt the practice was justified "on some occasions".

Ms Norman gave the example of a patient who refused to take a tablet, not realising that they had a chest infection and needed an antibiotic.

Professional concern

But the UKCC says the patient's interests must be paramount at all times, and the nurse has to be prepared to be accountable for their actions.

Any abuse of the procedure would be professional misconduct which could lead to them being struck off.

Joe Nichols, professional officer for mental health and learning disabilities at the UKCC, told BBC News Online said the guidance was aimed at helping staff make decisions in individual cases.

"In certain exceptional circumstances, it can be done," he said.

"But we're trying to find a way to assist the registered nurses in coming to a decision as to whether to do it or not."

Harry Cayton, chief executive of the Alzheimer's Society criticised the rules: "People with dementia are too frequently given powerful sedative and anti-psychotic drugs which make life easier for care staff.

"This may not be in the best interests of the patient.

"We are concerned that the guidelines don't go far enough to help ensure that older people, and in particular people with Alzheimer's who are unable to give their consent, are only given drugs which are in their best interests."

Tessa Harding, of Help the Aged said the guidelines set a dangerous precedent. "They violate the principle that patients must consent to treatment, having been fully informed and consulted. Everyone, including older people, has the right to refuse treatment."

The BBC's Rachel Ellison
"Any deliberate deception inevitably posses ethical problems"
The BBC's Valerie Jones
"The rule must be that the medication is essential"
See also:

23 Aug 01 | Health
Dementia care 'sub-standard'
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