Covert medication & DoLS

Well week 2 into this new weekly blog, oh how that week has flown by dear reader!

So this weeks interesting issue that was discussed at length was all about ‘Covert Medication’ and the implications of ‘Deprivation of Liberty Safeguards’ (DoLS).

Now before I start I have to state I am not an authority on this subject and will always state in all things DoLS –

“If in doubt ALWAYS contact your local DoLS team for clarification on the issue presenting”

and for those reading who deliver support with DoLS and/or the Mental Capacity Act involved will understand there are still a myriad of grey areas when it comes to this subject – “what is and what isn’t” – what I hope to provide in this blog is the benefit of the advice I give, have gained and some pointers for you to consider.

The question that started the whole discussion off was:

Do I need a DoLS for administering covert medication where the person involved lacks capacity?

I must admit my first response was “If it is covert and the person involved lacks capacity to understand the reasons/action taken even after formal support to understand and fully retain the information, then the answer would be YES!”

However it then got me thinking was I fully right in that assumption so I gathered some further information asked a few close connections with further insights into DoLS and MCA and was able to reach the following conclusion.

You do indeed need a DoLS for administering covert medication when the covert medication is either used as a controlling and/or sedative medication.

For those medications that are NOT classed as controlling and/or a sedative then a ‘Best Interest’ meeting and agreement should be used in conjunction with a GP or Pharmacist sign off

So how did I arrive at those statement. Well after consulting the Mental Capacity Act 2005 which includes the Deprivation of Liberty Safeguards and checking with the current advice listed on the NICE guidelines for managing medications in care homes – link, as well as my connections in conversation it was semi-clear the difference between needing (DoLS authorisation) and not needing (Agreed Best Interest) lies in the nature of the medication and what it was being prescribed for.  

And to put it in a form of a flow chart was the best way I could then let the care homes I am working with understand my finding:


Finally I must refer again to the statement made earlier in the blog –

If in doubt contact your local DoLS team for clarification on covert medication issue!

So there goes week 2 of these blogs I hope again this has either assisted you or got you thinking about the subject and with all my blogs I welcome your comments on the subject matter and/or blogs you wish to see in the future.

I thank you for reading and till the next blog, take care



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