The diverse roles for pharmacy teams in healthcare settings may facilitate exposure to a variety of situations involving covert administration of medicines.

The RCP recommends that when initiating covert administration of medicines, the proposed treatment plan is discussed with a pharmacist to ensure any dosage form alterations (e.g. crushing) are safe and effective for patients. Any medical, cultural or religious dietary requirements should also be discussed (e.g. gluten-free, Jewish or Muslim patients).

As part of their wider medicines optimisation agenda, pharmacy teams may wish to review medicines to determine whether they are still required, and whether dosage burdens can be decreased. As manipulation of dosage forms for administration with food and drink would generally be considered as unlicensed (off-label) use, teams might also consider whether there are alternative licensed medicines or formulations available for using the most appropriate route of administration.

In practice, only medical or dental practitioners can authorise the use of unlicensed medicines and those who administer such medicines share a degree of responsibility with the prescriber. The risk of medicines degrading when added to food or drink must be balanced against the risk of not giving the medicines. There may be particular risks associated with crushing tablets or opening capsules, particularly if they are enteric-coated or modified release preparations.

Pharmacy teams who care for and know particular patients well may also find themselves involved in multidisciplinary best interests meetings where decisions to initiate covert administration may be made, or in mental capacity assessments. Once a decision is made to initiate covert administration of medicines, pharmacy teams may play an important role in encouraging nursing staff to continue to offer medicine openly and ensuring covert administration practices are regularly reviewed (e.g. weekly) to determine whether they are safe, documented and still necessary.