Zopiclone in care home under DoLS- review duties/MCA/DoLS safeguards

Law and practice Mental Capacity Act
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i would be grateful for views on the legal framework governing the continued use of zopiclone in a care‑home setting for a person with Alzheimer’s disease who lacks capacity and is subject to a DoLS authorisation.

Background

• Zopiclone 3.75 mg was prescribed in hospital as a short‑term (14‑day) measure.

• The discharge summary stated it should be reviewed by the GP.

• The person was admitted directly to a care home under a court‑approved placement and remains there.

• It is unclear whether any GP review has taken place since admission.

Questions

1. Medication review:

Who is responsible for reviewing a short‑term sedative when someone moves from hospital to a care home, and what are the expected timescales?

2. MCA / best interests:

What MCA processes are required if a sedative‑hypnotic is continued beyond the original short‑term period (capacity assessment, best‑interests decision, documentation)?

3. DoLS / restraint:

At what point could ongoing use of a sedative for behavioural management amount to chemical restraint under MCA/DoLS, and what safeguards are required?

4. Covert medication:

If such medication were given covertly, what authorisation and documentation would be required?

I am seeking clarification of the legal and regulatory framework, not medical advice.

Thank you.

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giving-medicines-covertly-quick-guide.pdf

Covert administration of medicines - Care Quality Commission

Can answer your questions.

Zopiclone is a hypnotic ordinarily used to help people get to sleep but consideration also needs to be given about any increased risk of falls etc. Medication to manage the behavioural and psychological symptoms of dementia should be part of a best interest plan where the person lacks capacity with regards the treatment plan but, in my lay view, describing the use of zopiclone as such would be a stretch.

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Hi Maggie. All care home residents are registered with a GP, they are responsible for medication reviews and repeat prescriptions.

A proportionate MCA and best interests process would be needed, a simple GP note entry would suffice for a prescription.

I’ve not known Zopiclone to ever be used for behavioural management, only to aid sleep. It’s sedative qualities are unlikely to be felt during the day, its unlikely it would be considered chemical restraint

Covert medication would be subject to MCA so capacity assessment and best interests guidance, additional clinical prescriber and pharmacist consideration is required, guidance is issued by CQC here Covert administration of medicines - Care Quality Commission and links to care home registration regulations and many local authorities have something on this as part of their safeguarding adult policies and procedures.

hope that is helpful

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Thank you all for your replies. The prescriber in hospital setting says it was for “agitation at night”so it’s not clear to me if that is to help him sleep, or to control the behaviour. As one of his attorneys under his LPA can I request the care notes and medication notes/reviews from the care home manager to get more clarity going forward? If best interests decisions re this medication are required, should I be consulted? Thank you for the links to CQC etc. They are really helpful.

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If the LPA you are named on covers health and welfare AND the person now lacks mental capacity on this healthcare matter, then you have the same rights of access to records as the person you are an Attorney for would have and should certainly be consulted as part of any best interests decision making.

I suggest you notify the care home and the GP that you are interested in the rationale for prescribing and wish to be involved in the next review, that should lead to them involving you in a conversation. I would also recommend providing the care home and GP with a copy of the LPA naming you for their records.

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I can confirm that I am a named attorney on his registered LPA for H & W and that he lacks capacity to make decisions about his care and residence, and is under a standard DoLS authorisation in a care home. How can I get the details of the GP for the care home - I’m assuming it would not be the same GP he had when living at home? Thank you so much for clarifying what has been difficult to unravel up to now.

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Its unlikely to be the same GP he had when at home it is usually a GP practice near to the care home. Staff at the care home will be able to give you the contact details for the GP and what days they usually attend the home to review residents.

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I’ve been put into War Mode! [Long story - don’t ask.]

The DOLS is irrelevant in this situation - absolute basics.

NOBODY lacks capacity. A person may lack capacity for a specific decision or a basket of closely related decisions if the lack of decision-making capacity is demonstrated. The burden of proof is on the assessor(s). But.. but.. it’s a free-for-all, cuz nobody checks these things with any regularity.

On the zopiclone background:
The zopiclone situation is not specific to zopiclone. All sorts of drugs (ala medicines) fall into the same situation, thus proving my long experience that NOBODY cares.

The primary responsibility falls on the prescriber (if a doctor) who is burdened to repeat the prescription. Don’t take my word for it check the GMC prescribing guidance (freely available online, which is more than ‘guidance’ - it’s a noose). Argue with the GMC - not me. The only exception is where there is a clear written responsibility-sharing document that alters the above.

The same as ever - it’s all written in the MCA 2005 and its Code of Practice. But who cares. Nobody except me - reads these things with any regularity. Look, in health and social care/services these days, if it’s longer than a 15-second read; it’s not going to be read.

Look for the 3 to 5 page Best Interests decision-making documentation and apply each line of S4 MCA 2005 to it. If it’s wishy washy then don’t be surprised.

‘Chemical restraint’ is a buzz word used to justify anything under the sun. Let’s see a medical doctor put on paper “Zopiclone is being used for chemical restraint’.” This is unlicenced use and immediately engages the GMC’s prescribing guidance and the MHRA rules. But wait - nobody cares!

Difficult to say - probably 100 pages of proper documentation. Nobody has time for that.

Just sue or haul people to their respective regulators.

Laughable if it wasn’t such a serious matter. It’s the age-old agitation trick - that’s used to do whatever they want!

If you’re me in War Mode, I’d request the totality of all records wherever they may be. But.. but…everybody is not me.

The care home manager is not responsible for the prescribing of zopiclone or any other medication. Seems like a dead end. Go for primary sources of responsibility. In War Mode - I call it going for the jugular.

Anybody with such a close interest such as LPA for H&W, should be or have been consulted. The law says so! Section 4(7)(b) MCA 2005 but I should possibly add the traditional ‘I’m not a lawyer’ thing; so what do I know.

War Mode is not for everybody - it raises merry hell!

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Hi Russell, thank you for taking the time to reply at length to my questions. I envy your War Mode, and wish I could adopt it here, it’s an uphill struggle. I’ve tried to follow the MCA to the best of my understanding as an attorney, but as you say baldly- nobody cares! It does seem that way. I’m even wondering what “merry hell” might look like!

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