Mental Health Hospital

The Nature of Crisis and the Level of Crisis

Covert administration of medicines should only be appropriate or necessary when the individuals have actively refused the medication (Barreto, 2017, 28). The person must have also been judged if he has the capacity of understanding the refusal. The circumstances that are usually exceptional where the individuals that covert the administration of medication can put into consideration so that the person affected is prevented from missing the important treatment. This occurs under certain circumstances or when the consent could be absent, for instance; medication of the individual should be considered very important for that particular individual’s wellbeing and health; the regular encouragement and information by the member of the team to whom that individual could be having the good rapport should encourage the compliance for his medication; decision for administering covertly the medicines should not be the routine and therefore, should be by emergency or contingency measure which has been planned by a multi-agency way; the benefits and the risks to the treatment proposal should be written within the notes for the individual; a multidisciplinary team should discuss if the approach they are using has been recommended in that particular circumstance, the kind of action taken, decision made and documentation has taken for all the individuals present (Riley, 2016). The opinion of the pharmacist to be sought for the correct medication form to be administered to the person being affected, for example, the syrups. A pharmacist involved when making the decisions that regard the covert administration of medication. The administration method should be accepted by the pharmacist and then recorded with the care plans by earlier opportunities.

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The Advance Decision to Refuse Treatment (ADRT), has been defined within the capacity for mental Act 2005. An individual may at sometimes when he or she is having a mental capacity in doing so, can make the decision so that he or she refuses the treatment specifically at the future date especially lacking the capacity for doing so. For instance, if the treatment to be offered to the person is for the life-sustaining, it should be documented, be specific and witnessed. The ADRT to some extent is not applied in some treatments that are being given by the authority within the Mental Health Act 1983. According to Case (2016, 174), approved mental health professional (AMHP), the practitioners, professionals that have been approved to do particular functions under this Act. The function would involve coordination of the assessments of the Mental Acts, making of various applications towards the detention following the use of the Act and if agreements have been made, and when the agreements are made towards the responsibility conditions by the clinicians.

According to the Mental Health Act 1983, it is set out that the powers and duties for detaining the authorities are having concerning the patients being detained. For taking the particular action, it has placed the powers and the duties with managers in the hospitals. The NHS trust would mean for the organization alone (Rucker and Nutt, 2018, 200). For the Solent NHS Trust, which ultimately is the board’s responsibilities. Particularly, the board should always ensure the patients being detained, according to the conditions that are in the provision in the Act, and their care and treatment are accorded fully with the provisions, and they are informed fully with and also supported for exercising the statutory rights.

The Decision Making Process

The reason for the capacity assessment for consent and the medication refusal by the patient is the process that has been identified by the Medical Capacity Act 2005 (MCA) and must use when an individual is not able to demonstrate the understanding for either one or more different parts of the test. The reasonable account details of the assessment should be documented clearly within an individual’s documentation. The works by Sharples and Allen, (2017, 165) indicates that, according to the MCA practice code, it is stated that if for instance the professional health care or the doctor proposes the treatment or the examination, the capacity of the person must be assessed according to the consent. Though ultimately, it remains the responsibility of the professional who is responsible for making sure that the assessment of the capacity has been done. The rest of the carers and practitioners retain the responsibility so that they can participate during the discussion of the assessment. Within the hospital, the practical assessment of capacity to be used when making the specific decisions are made by senior career or nurses directly concerned by the person during the process of making a decision. The nurses, therefore, determine if the decisions made are supported by multi-disciplinary members. The proposal by the nurses should be not to administer the medicines covertly while in isolation.

This requires people involved in the decision-making process to have the thought about the correct course of action can be good to an individual while considering about the future and current interests of the individual lacking the capacity and decides the best action course for that particular person. For instance, if an individual is found to lack the mental capacity of understanding the consequences for refusing his or her medication, the multidisciplinary discussion or meeting for the best interests involving the parties who are relevant should be held unless the situation is emergency. If possible, the meeting about the formal best interest is done. The findings by Harstäde et al, (2018, 8) reveals that the discussion or meeting in the Best Interests should include; the relevant professionals within the healthcare system that involves the pharmacist and the prescriber and also the staff care delivery of the person. The member of the family who will be capable of communicating the interests and views of the person. Best interest discussion or the meeting usually is being held so that there is an agreement on whether is correct for the administration of certain medicines that are specific without the knowledge of the person under treatment (covertly) and also the best opportunity of ensuring the families become aware of the decision made.

The pharmacist is requested so that he/she may review the person’s medication since all the medications cannot be suitable when administered covertly. A pharmacist is able to assess the medication’s properties if they cannot be affected significantly by covertly administering those (Youngstrom et al, 2017, 331). A pharmacist should make sure that supply occurs according to the individual’s interest and should be able to give the advice for best appropriate method for administering the medicines.

The covert administration of medication may and likely to be challenged with the bodies for inspection unless the appropriate written records have been put in place for the support of the process. It is inappropriate to take the action the ‘ad hoc’ for the verbal direction and the instruction written to administer the medication covertly without the process for the decision of Best Interest since it can be very liable to the challenges legally (Bujar, 2018). The care provider and the prescriber should be having the documentation for both the assessments of mental capacity and the issues concerning the medication, understanding and for the decision of the Best Interest pathway which can then covert administration.

Generally, the covert medications are supposed to be put together with the little amount of drink or food possibly. It results in the increase of the doses prescribed are taken. According to (Trick, 2013, 434), the refusal of food or the drink which contains the medication should be documented or recorded on the Medication Administration Record (MAR) prescription/sheet as has refused and then documented clearly in within the section of the evaluation for the individual person’s care plan. It is also noted for example, if the person can only consume certain drinks or foods the way the dose is uncertain.

Clearly stated plans used for covert medication

Once the decision of best interest is made for the covert administration of medication, therefore, the clearly formed plan for reviewing the regular requirement for ensuring that the medication administered during the administration process should remain appropriate and recent to an individual, for instance, to make sure medication is correct and the dosage restriction is least possible (Ziegler et l, 2017, 30).

The Mental Capacity Act (MCA) 2005 provided the frame which empowers and also protects the vulnerable persons who are not capable of making own decisions (Tan and Richards, 2015, 113). The Independent Mental Capacity Advocate (IMCA), who is the person that has been appointed in support of the individual lacking the capacity and is not having someone who can speak on his or her behalf. IMCA usually makes the representation of the individual’s feelings, wishes, values, and beliefs. They also bring the decision maker attention to all the factors relevant to decision making. The decisions made an advance for the refusal of treatment have certain rules that statute containing clearly safeguards and used to confirm if people are able to make the decisions advance so that they can refuse the treatment should they lose the capacity in their future lives. According to (Burgart et al, 2018, 188), the Act indicates clearly that the advance decision does not have any application for the treatment, in which the doctors consider to be necessary for life-sustaining unless certain formalities that are strict are compiled upon. The decision made ultimately for the administration of medicines covertly should be the one which is informed and is agreed upon by a multidisciplinary team who care for the person.

The practitioners who have been registered are supposed to be reflecting on the aims of disguising medication for treatment. Treatment should be necessary for the prevention of deterioration, lifesaving and to ensure the improvement of the individual physical and mental health. The findings by (Rasoal et al, 2017, 313) show that the registered nurse who has been involved in doing the covert administration of medicines can be aware fully of the intent, implications and the aims of the treatment. They are not supposed to act in the isolation and unilateral. The practitioners should be accountable individually for their own practice. For instance, if an individual is detained lawfully under the section of Act for mental health, certain forms of disguised or forced medication have been recognized by the law. The doctors or the nurses should be referred to the mental health Act and the practice code. Therefore, the decision for giving of covert medication must be by multidisciplinary and also to be planned.

The information to be provided should be given either orally or in the form of writing. All the wards will be having the information written to be provided to the patients. According to (Hinsliff‐Smith, 2017, 295), the information should be further written in various languages and also in form of formats that are easily read which are available and has been indicated in Mental Health Act 1983 site. For example, if the person cannot read or has difficulty in reading, therefore, any member of staff should assist the person by reading the written information for the patient, unless not required by the patient. The findings by (Austin, Saylor, and Finley, 2017, 399) show that the staff who is discharging the duties should be taking all the practical steps by ensuring that the information is provided to the patients through the method that can be understood by the patient easily. This would involve the consideration by using the interpreter.

The carers or even the advocates can be included in cases where patients wish and are lacking the capacity for understanding. The staff who is in charge of these duties should take all the practical steps so that the information can be provided in a manner that the patients are able to understand. Within the hospitals, the capacity for practical assessment of the specific decisions made with a nurse or the senior carer concerned directly with an individual during the time when the decision is being made (Forough et al, 2018, 71). Therefore, the assessments will always benefit, especially when the family member has been involved, the closest friends and the other people taking the care especially if there could be doubt on decisions to be made. The covert administration for the medicines should only be appropriate and necessary for such cases for, example when an individual actively refuse the medication and have been judged such that they are lacking the capacity for understanding the consequences for their refusal for the medication.

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References List

  • Austin, C.L., Saylor, R. and Finley, P.J., 2017. Moral distress in physicians and nurses: Impact on professional quality of life and turnover. Psychological Trauma: Theory, Research, Practice, and Policy, 9(4), p.399.
  • Barreto, S., 2017. Covert administration of medications in old age psychiatry: a reflection. JGCR, 4(1), p.28.
  • Bujar, M.G., 2018. Development of a Roadmap and Evaluation of Quality Decision Making Practices During Medicines Development, Regulatory Review and Health Technology Assessment.
  • Burgart, A.M., Magnus, D., Tabor, H.K., Paquette, E.D.T., Frader, J., Glover, J.J., Jackson, B.M., Harrison, C.H., Urion, D.K., Graham, R.J. and Brandsema, J.F., 2018. Ethical challenges confronted when providing nusinersen treatment for spinal muscular atrophy. JAMA pediatrics, 172(2), pp.188-192.
  • Case, P., 2016. Negotiating the domain of mental capacity: Clinical judgement or judicial diagnosis?. Medical Law International, 16(3-4), pp.174-205.
  • Forough, A.S., Wong, S.Y., Lau, E.T., Santos, J.M.S., Kyle, G.J., Steadman, K.J., Cichero, J.A. and Nissen, L.M., 2018. Nurse experiences of medication administration to people with swallowing difficulties living in aged care facilities: a systematic review of qualitative evidence. JBI database of systematic reviews and implementation reports, 16(1), pp.71-86.
  • Harstäde, C.W., Blomberg, K., Benzein, E. and Östlund, U., 2018. Dignity‐conserving care actions in palliative care: an integrative review of Swedish research. Scandinavian journal of caring sciences, 32(1), pp.8-23.
  • Hinsliff‐Smith, K., Feakes, R., Whitworth, G., Seymour, J., Moghaddam, N., Dening, T. and Cox, K., 2017. What do we know about the application of the Mental Capacity Act (2005) in healthcare practice regarding decision‐making for frail and older people? A systematic literature review. Health & social care in the community, 25(2), pp.295-308.
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  • Youngstrom, E.A., Van Meter, A., Frazier, T.W., Hunsley, J., Prinstein, M.J., Ong, M.L. and Youngstrom, J.K., 2017. Evidence‐based assessment as an integrative model for applying psychological science to guide the voyage of treatment. Clinical Psychology: Science and Practice, 24(4), pp.331-363.
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