There are a number of resources available to advise healthcare professionals on the stability of medicines when mixed with food or otherwise altered from the manufacturer's presentation.

The Handbook of Drug Administration via Enteral Feeding Tubes (Pharmaceutical Press) provides guidance on whether formulations can be crushed prior to administration. It also highlights any incompatibilities with food. The NEWT guidelines (North East Wales NHS Trust) provide similar information.

Numark Information Services has access to these resources and can advise members accordingly, call 0800 783 5709*.

To support our members when providing advice on the suitability of covert administration, Numark Information Services have designed a document to support the decision making process. The resource forms a checklist of the questions or processes that should occur prior to covert administration. It also details the pharmaceutical aspects that pharmacists are advised to consider. The document can also act as an audit trail of advice provided, confirming the appropriateness of the method of administration. It can be downloaded from NumarkNet.

Covert administration of medication can be a complicated issue with legal, ethical and pharmaceutical perspectives. Pharmacists who are prepared and informed about the necessary considerations will be in a better position to provide accurate and timely advice and assistance.

In every situation it is important that any advice provided is recorded in order to demonstrate compliance with the guidelines of the Mental Capacity Act and also the NICE guidelines. These exist to protect healthcare and social care staff from legal action when making decisions on behalf of or providing care for people who are assessed as lacking capacity.

Reference Sources

1. The Mental Capacity Act 2005 - Guidance for providers. CQC Dec 2011
2. https://www.sps.nhs.uk/articles/what-legal-and-pharmaceutical-issues-should-be-considered-when-administering-medicines-covertly-2/
3. Making decisions - A Guide for people who work in health and social care. Office of the Public Guardian (OPG603)
4. Mental Capacity Act 2005. Legislation.gov

*Calls may be recorded for training and quality control purposes.