Healthcare Staff's Experiences on Administering Medication Covertly in Elderly Residential Care Settings: A Systematic Literature Review

Aim of the Review To explore healthcare staff’s experiences regarding the practice of covert medication in elderly residential care settings. Background Studies indicate that the practice of administering medication... [ view full abstract ]

Aim of the Review
To explore healthcare staff’s experiences regarding the practice of covert medication in elderly residential care settings.

Background
Studies indicate that the practice of administering medication covertly may be prevalent in long-term care settings for older people. This raises questions about how covert medication is understood in terms of ethical, legal and efficacy issues.

Search and Review Methodology
A preliminary review was undertaken to establish the existence of literature on the topic and identify search terms. The bibliographic databases CINHAL, PubMed, Medline, PsycINFO, EMBASE and the relevant grey literature were searched in December 2015 and January 2016. Primary research studies using a qualitative methodology design, reporting on healthcare staff’s experiences on administering medication covertly in elderly residential care settings, were eligible for inclusion in this review. The included studies were systematically evaluated for their methodological quality, separately by the writer and supervisor, using the Effective Public Health Practice Project screening tool. The findings extracted from the primary papers were analysed using a thematic analysis framework by the writer and supervisor.

Findings
The search identified 724 references. 29 full-text papers were obtained, 26 of these were excluded, leaving three papers included in the review. The three studies scored high in the methodology assessment but differed substantially in design with implications for data extraction. Three themes were identified: covert medication as a deliberate treatment intervention, covert medication as being a necessary treatment intervention and ethical and legal aspects of covert medication encompassing ethical and legal implications and consequences for staff.

Conclusion and Implications
This systematic review reveals that there is a problem with covert medication. The limited research available varied in methodology design, population groups and research questions, which could be explained due to the lack of a general definition of covert medication, as well as the fact that covert medication is a sensitive issue. Further research on this topic is recommended.