Mental Capacity Act

Mental Health

1. Explain the principles of the Mental Capacity Act 2005 2. Summarise the law relating to the administration of medicines without patient consent in relation to the Mental Capacity Act 3. Critique the process involved in successfully administering medicines to a patient covertly

What are the learning outcomes for the Mental Capacity Act 2005 lecture? (3 points)

1. Part 2 introduces the Mental Capacity Act 2005

What section of the lecture is introduced in Part 2? (1 point)

1. A person must be assumed to have capacity unless it is established that they lack capacity 2. A person must not be treated as unable to make a decision unless all practicable steps to help them make the decision have been taken without success 3. A person must not be treated as unable to make a decision just because they make an unwise decision 4. Any act done or decision made for a person who lacks capacity must be done or made in their best interests 5. Before an act or decision is made, consideration must be given to whether the same purpose can be achieved in a way that is less restrictive of the person’s rights and freedom of action

What are the five key principles of the Mental Capacity Act 2005? (5 points)

1. A person lacks capacity in relation to a matter if, at the material time, they cannot make a decision for themselves about that matter 2. This must be because of an impairment of the mind or brain 3. It can also be because of a disturbance in the functioning of the mind or brain, which may be temporary or permanent 4. Lack of capacity cannot be established only by reference to the person’s age, appearance, condition or behaviour

When does a person lack capacity under the Mental Capacity Act? (4 points)

1. They are unable to understand the information relevant to the decision 2. They are unable to retain that information 3. They are unable to use or weigh that information as part of the decision-making process 4. They are unable to communicate their decision by any means

When is someone unable to make a decision for themselves? (4 points)

1. If a person lacks capacity, any action taken or decision made on their behalf must be in their best interests 2. The decision maker should consider whether the person is likely to regain capacity 3. The decision maker should encourage and support the person to be involved in the decision as fully as possible 4. The decision maker should consider the person’s past and present wishes, feelings and beliefs 5. The decision maker should take into account the views of other concerned individuals 6. If the decision relates to life-sustaining treatment, the decision maker must not be motivated by a desire to bring about the person’s death

What does “best interests” mean under the Mental Capacity Act? (6 points)

1. ADRT means advance decisions to refuse treatment 2. ADRT allows people to make a decision in advance to refuse treatment if they lack capacity in the future 3. LPA means lasting power of attorney 4. People over 18 can appoint one or more people to look after health, welfare and/or financial decisions if they later lack capacity 5. IMCAs are independent mental capacity advocates 6. IMCAs safeguard people who lack capacity for important decisions, such as where they live or serious medical treatment, when they do not have family or friends to represent them

What are ADRT, LPA and IMCAs under the Mental Capacity Act? (6 points)

1. Covert administration is when medicines are administered in a disguised format 2. It may be appropriate when a person refuses their medicines 3. The person must be judged to lack capacity in relation to that medicine decision 4. The medicine must be deemed essential to the person’s health and wellbeing 5. Covert administration should be a last resort 6. The decision must be made in the patient’s best interests 7. A best interest meeting should involve the prescriber, pharmacist, relevant healthcare staff and a family member or advocate

What is covert administration of medicines and when may it be appropriate? (7 points)

1. The decision should be medicine-specific 2. The decision should be time-limited 3. The decision should be regularly reviewed

What rules apply to decisions about covert administration of medicines? (3 points)

1. Medicines should always be offered overtly first 2. A care plan for covert administration should be completed 3. Manipulating a dosage form is usually unlicensed 4. Covert administration must always be quantifiable 5. Avoid mixing multiple medicines together 6. Avoid giving medicines with food or drink if there are known interactions, such as milk with ciprofloxacin or tetracyclines 7. If absorption or effect may be altered, consider whether the medicine’s effect can be measured 8. Consider acceptability to the patient and the safety of crushing tablets, such as cytotoxics

What practical points must be considered when covertly administering medicines? (8 points)

1. BNF for Children 2. Handbook of Drug Administration via Enteral Feeding Tubes, available via MedicinesComplete 3. The NEWT Guidelines 4. Medicines for Children website

What helpful resources are available for covert administration of medicines? (4 points)

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