No written local policy exists which deals with the administration of medications covertly in this way. The meeting should be between healthcare professionals and family members. However, there are times when very severely incapacitated patients can neither consent nor refuse treatment. In much of the developed world, such deficiencies are rare; this is due to 1. For example, if a patient has not been taking their antihypertensive medication for a fortnight but their recent blood pressure readings are within acceptable parameters, it may be more appropriate to continue without medication and for this decision to be reviewed at defined intervals. Independent Mental Capacity Advocate resources.
The harmful effects of untreated psychosis are well documented Loebel et al. The alternatives to concealed medication are non-treatment and forcible treatment. In a study of 50 elderly patients, 79 % received their medication surreptitiously. The plasma concentrations of this active metabolite, however, are less than 10% of that of ibutilide. It presents many legal and ethical questions which I will discuss. Registered Mental Health Nurse in the administration of drugs to a Service User within and area of legal and ethical matters. I will be examining the area of Covert Medication in a Dementia Patient.
Certain jurisdictions believe that a doctor who proceeds without consent will be liable for trespass, assault, or battery, regardless of whether the doctor believed that what he or she did was good for the patient. The ultimate scope and impact of Hargrave may not be known until a decade from now; it is worthwhile to consider the possible effect of the decision on the use of advance directives for psychiatric treatment. No one else can give consent for an adult, someone over the age of 18 or 16 in some circumstances. For purposes of this assignment the service user will be known as Winifred Clark. After completing the necessary training, pharmacists should advise the multidisciplinary team and patient representatives on the benefits and risks of each medicine for the particular patient. At a minimum, however, it seems likely that Hargrave, as it becomes more widely known, will chill enthusiasm for psychiatric advance directives among many clinicians. If the tympanic membrane is not intact, do not irrigate the ear.
It also contains useful information stating what changes of circumstance would trigger a review of the best interests decision. Treatment with antiarrhythmics should generally be avoided. In order to avoid health complications from errors in medication administration, it is important that a clinician compare the medications that a patient is already receiving with new. Although there have been no identified studies of covert medication administration in hospital emergency departments, the article reviews the prevalence of this practice in other clinical settings. Consent to medical treatment is probably the most significant principle underlying the law relating to treatment of psychiatric patients. Guidelines need to be provided to medical professionals and carers of adults with incapacity about how to act if the use of covert medication is considered. However, to seek consent from the incapacitated is futile.
Patients with progressive dementia or inadequately treated major mental illnesses often lack the capacity to make decisions. Inspiring people and influencing them are tough challenges for any administrator to overcome. If there is no way to establish the potential effect that the medicine is having, discuss this with the prescriber. There is much potential for error because of the complexity of the medication administration process. To improve the care of patients with severe mental illness, clinicians and family members sometimes resort to concealing medications in food or drink--a practice referred to as Covert Medication. Wright 2002 suggests that the practice of covertly administering medications is one that has potential to endanger public safety and breach legal and professional requirements. Hospital records show that, on a prior admission, the patients and staff were bashed badly during application of physical restraints.
For example, in the United Kingdom relatives do not have such powers, except in Scotland. Both studies reported that covet administration was often done secretly and without discussion, probably for fear of professional retribution, Kirkevold and Engedal 2005 concluded that even if, as most carers and some authorities thought, covert administration can be justified, the poor recording and secrecy surrounding the practice was a huge cause of concern. Results of the first two studies are shown in the tables below. The key ethical principles relating to the use of concealed medication are autonomy, justice, beneficence, and respect for persons. People who eat a varied diet are unlikely to develop a severe primary vitamin deficiency.
The incidence of these events, except for syncope, was greater in the group treated with Corvert than in the placebo group. All decisions about formulation should be made with regard to the individual patient. Corvert Dosage and Administration The recommended dose based on controlled trials see is outlined in the Table below. Covert or concealed medication sometimes becomes inevitable, but care should be taken to preserve the respect, dignity and rights of the patient by careful handling. Are we taking refuge under the utilitarian perspective of ends justifying means, of maximization of happiness, of greatest good for the greatest numbers, or is that only a comforting shield? Patient Safety and Quality, Medication Administration Safety ii. In some countries, the practice is not addressed by laws covering healthcare. The medical events reported for more than 1% of the placebo- and ibutilide-treated patients are shown in the following Table.
Should they not come in the same category? For purposes of this assignment the service user will be known as Winifred Clark. A bipolar or psychotic patient who is medicationally non-compliant is not capable of making informed decisions and may actually have delusional thought and feelings. Unfortunately this practice is also used in pediatrics, where informed consent is not required. The capable administrator is a person who has the right mixture of intelligence, imagination, technical knowledge, communication skills, humor, adaptability, ambition, aggressiveness, and discipline. They may reject further treatment if they feel that the diagnoses were unfounded, or that they have gotten better on their own. Flowchart of the paper In summary, it can be concluded that the stance to be taken in our decision on covert medication must be based on clinical evidence. Any use of covert medication must be recorded, and the process of administration in this manner must be kept under regular review.
The moot point is whether covert medication can be resorted to in such an emergency. After six weeks X was reviewed by the consultant psychiatrist and she recommended that he continue taking the medication for a further six weeks, it was brought to her attention at this point that X was being administered his medication covertly within foodstuffs. To increase compliance, medications may be administered surreptitiously in food or drink. For an administrator, managing employees successfully is not only a challenge, but also a talent. Laboratory Test Interactions None known. Legal Considerations Legally, treatment without consent is permissible only where common law or statute provides such authority. The best administrators all possess one talent—the ability to discover and capitalize upon.