Not taking Medication

[Steve115]

My wife is now in a NH due to complex nursing needs. One issue that has arisen before but not been a significant issue is refusal to take medication including Risperidone. The medication was prescribed due to significant agitation, hallucinations and anger. It has been very successful to date.

However, suddenly on Friday last she refused all medication and has taken nothing since. The result is what can only be described as a prolonged psychotic episode, refusal to take medication, eat, drink properly and of course anger directed at me in particular. As a result I have not been able to visit as she explodes and demands that I leave (and not go back). The NH (nursing sister) have advised that at this stage they cannot force her to take anything.

I checked with the AS site with regard to what can be done. The focus of the advice is to a carer at home and advises discussing options with the GP. Obviously I cannot now do that and wondered how long it might be before the NH call a medic to get this sorted out. Should I have any expectation.

Can anyone advise please?

Many thanks

Steve

 

[Beate]

They might not be able to force her but have they never heard of giving medication covert, ie hidden in pots of yoghurt or mousse? Or ask whether there is a liquid variation that can be put in drinks. A doctor can authorise that no problem.

 

[Steve115]

Thanks for getting back so quickly Beate. Apparently hiding medication is illegal in hospital and NHs though it would be something I could have done at home. As I understand it Risperidone does not have a liquid variation as it is slow release.

I will discuss getting in a doctor if they have not done so by tomorrow.

Steve

 

[Steve115]

Beate,

You are right there is an oral version of Risperidone. I will follow that up.

Mind you she will have to agree to take it.......

Many thanks

Steve

 

[Kevinl]

.Apparently hiding medication is illegal in hospital and NHs

According to the NICE guidelines "The covert administration of medicines should only be used in exceptional circumstances when such a means of administration is judged necessary, in accordance with the Mental Capacity Act 2005" Link below.
I see covert medication used everyday, there's a list in the medications room of who they can covertly medicate in the nursing home and in the NHS secure unit my wife was previously in they did it there too, the doctors told me they had to do it if my wife refused.
Who said it's "illegal"?
K
Edited to add a link to the CQC site.
https://www.nice.org.uk/guidance/qs85/chapter/quality-statement-6-covert-medicines-administration
https://www.cqc.org.uk/sites/default/files/20161122_briefguide-covert_medication.pdf

 

[Shedrech]

hi @Steve115
is the 'problem' that your wife is considered to still have capacity, so they are saying she has to consent?
even so, a doctor can authorise the covert administration of medication
my dad no longer has capacity, and even then, strictly, the carers were not allowed to give him medication without his consent - I wrote to his GP explaining that I am his daughter and have POA health & welfare - I said I wanted my dad to have his medication as it keeps him settled, and so gave my permission for meds to be given covertly - I explained that any 'refusal' was a kneejerk, baseline negative reaction rather than a 'reasoned' refusal and that often the problem was that dad had forgotten the process so could not take the pills - I asked that it be acceptable to give his meds hidden in food or drink and suggested a yogurt - I also asked that the GP write to the care home manager stating that the staff had permission to give dad his meds covertly so that this was clear for them, could be noted on his records and all staff made aware
this was done, and the staff now make sure dad has his meds

by the way, just because your wife is living in a home doesn't mean that you have no right to ask that her GP be called in or that you are unable to speak to the GP yourself - I've asked that the GP/nurse be called to check dad out and it's been done

 

[Beate]

I have never heard covert medication being illegal if it's in the best interest of a patient who has lost capacity. Doctors authorise this all the time. Our NH had a doctor come in twice a week and and I was always free to speak to him if I had concerns or wanted something specific to be done. Don't leave it to the nurses!

 

[Shedrech]

hi @Beate
here's a link to the NICE website
care home staff cannot give meds covertly without permission
https://www.nice.org.uk/guidance/QS85/chapter/Quality-statement-6-Covert-medicines-administration

 

[Beate]

Yes and that permission can be given by a doctor, which is what I said.

 

[Steve115]

Thank you all for your interesting feedback. It is a minefield and both sides are right. With certain permissions medication can be given covertly however that is mainly with patients who have lost capacity. In the event that there is still capacity the patients wishes should be followed. And yes it is illegal/unlawful in some circumstances. The following was useful:

psnc.org.uk/sheffield-lpc/wp-content/.../Care-Home-Cover-Meds-Guidance.doc

This afternoon 2 doctors and the NH Sister evaluated my wife's capacity as the NH was getting concerned (I was excluded at the express direction of my wife). At the meeting the medics discussed and explained why the meds were necessary and the impact of not taking them. This was done by each in turn and in the end they all agreed that she still had the capacity to understand and therefore refuse any medication. So a standoff.

A little later the Sister asked what would change her mind and she said a drink preferably whiskey. So an agreement was reached in exchange for a drink she would take the tablets. She had her drink and later took the tablets, so hopefully she will slowly get back to normal over the next few days.

The medical opinion is that given so much of her life is out of control now this refusal to take the medication is a means of regaining some control.

Fingers crossed. I am off to have a drink now to steady my nerves.....

Steve