Concealing Medication: A Case Vignette

Her behaviors associated with her delusions and paranoia worsened to the point where the nursing home felt they could no longer safely take care of her. Her physician arranged transfer to a geropsychiatric acute hospital. In the hospital, an antipsychotic was administered mixed into her food. Her family gave consent for this, as she was considered to lack capacity for medication consent. On this regiment of concealed antipsychotic she improved and was considered ready for discharge from the hospital. Her original nursing home felt that they could not administer medication hidden in food, and alternative discharge sites were sought. Some residential care facilities for the elderly (RCFE) that specialize in dementia care offered admission and were comfortable with hiding the medication. Her physician felt this was not in compliance with the regulations that govern RCFEs. After discussion with the psychiatric staff at the hospital, a long acting parenteral antipsychotic was started, and efforts intensified to get her to take her oral medications again. That succeeded, and she was able to return to her original nursing home without the need to hide the medication.

The question of the role of concealment of medication was extensively discussed – is it acceptable ethically? If so, are there regulations that preclude it in settings such as nursing homes or RCFEs?

Concealing Medication: Pharmacist's Response

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Kirkevold, O., & Engedal, K. (2005). Concealment of drugs in food and beverages in nursing homes: cross sectional study. Bmj, 330(7481), 20–0. http://doi.org/10.1136/bmj.38268.579097.55