BMJ  2005;330:20 (1 January), doi:10.1136/bmj.38268.579097.55 (published 23 November 2004)

Primary care

Concealment of drugs in food and beverages in nursing homes: cross sectional study

¹ Norwegian Centre for Dementia Research, Vestfold Mental Health Care Trust, Tønsberg, Postbox 64, N-3107 SEM, Norway, ² Norwegian Centre for Dementia Research, Department of Geriatric Medicine, Ullevaal University Hospital, Oslo, Norway

Objective To examine the practice of concealing drugs in patients' foodstuff in nursing homes.

Design Cross sectional study with data collected by structured interview.

Setting All five health regions in Norway.

Participants Professional carers of 1362 patients in 160 regular nursing home units and 564 patients in 90 special care units for people with dementia.

Main outcome measures Frequency of concealment of drugs; who decided to conceal the drugs; how this practice was documented in the patients' records; and what types of drugs were given this way.

Results 11% of the patients in regular nursing home units and 17% of the patients in special care units for people with dementia received drugs mixed in their food or beverages at least once during seven days. In 95% of cases, drugs were routinely mixed in the food or beverages. The practice was documented in patients' records in 40% (96/241) of cases. The covert administration of drugs was more often documented when the physician took the decision to hide the drugs in the patient's foodstuff (57%; 27/47) than when the person who made the decision was unknown or not recorded (23%; 7/30). Patients who got drugs covertly more often received antiepileptics, antipsychotics, and anxiolytics compared with patients who were given their drugs openly.

Conclusions The covert administration of drugs is common in Norwegian nursing homes. Routines for such practice are arbitrary, and the practice is poorly documented in the patients' records.

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