From time to time, some care home residents will refuse to take their medicines. Before deciding to give medicines covertly, all other methods of giving medicines should have been considered (e.g. changing medication times, reviewing clinical appropriateness, stopping medicines where appropriate to reduce tablet burden or changing formulations). Only when these options have been tried, or if the refusal is due to a lack of mental capacity, can the care home consider giving the medicine in a covert way, such as in the resident's food or drink. Covert administration should always be done in the resident's best interests and should never take place if the resident has the capacity to make their own decisions about their treatment. 

Care homes will have a policy to ensure covert administration follows regulations and NICE guidelines. This will include:

• Ensuring the resident's mental capacity is assessed and documented by a healthcare professional
• Holding a best interests meeting involving care home staff, the multidisciplinary team and a family member or advocate (to follow best practice this should include
  the pharmacist)
• Ensuring the reasons for the decision that the resident lacks capacity are recorded and there is a proposed management plan
• How often to review if covert administration is still needed.

Pharmacists may be called on to give clinical advice during or after this process has been completed, but before giving advice always ensure that a best interests meeting has been held and that covert administration has been agreed.