retirement home re-evaluate its decision and harmonise the instruction to the resident with a clear legal definition. c) Prescribing and delivering drugs When visiting retirement homes, it was often established that the prescribing and delivering of drugs was more or less the task of the doctor and medical personnel in the institution. This can, however, be in contravention of ZPacP, which clearly defines both the doctor’s duty to disclose information and the obligation to obtain consent for treatment which must be provided by the resident or another legally stipulated person. A similar recommendation, as stated below, was also made during the visit to Idrija Retirement Home. •W  e (again) recommended to Dom Viharnik Kranjska Gora to point out to the doctor that if a new drug therapy was required or the therapy had to be changed, the resident’s consent, if they are able to give it or express their wishes, must be obtained following an appropriate explanation. If the resident is unable to give their consent, Article 37 of the Patient Rights Act must be considered and consent provided by the legal representative if one has been appointed, or another person as stipulated by this Act. In its response to the preliminary report, the retirement home stated that it agreed with the views expressed by the NPM and that it would consider them. During its visits, the NPM often pointed out the need for determining what “when necessary” means in terms of drug therapy. We mainly established that documents usually state when to give residents the drugs (if agitated, restless, suffering from insomnia and so on), and sometimes also when to administer them (in the evening, after lunch). However, only rarely have we found notes determining the highest daily amount of a drug or how many individual drugs a resident can receive in 24 hours. In addition to the recommendations provided below, the same recommendations were made to Gornja Radgona Retirement Home, Dr Jože Potrč Retirement Home in Poljčane, and Dr Janko Benedik Retirement Home in Radovljica. • I t was recommended that the Kidričevo Unit of Ptuj Retirement Home point out the urgency of limiting drugs to be administered when necessary to both the general practitioner and the psychiatrist. This, for example, means that it must be stated how many units of a drug can be administered in case of pain and the maximum number of units in 24 hours. Such prescriptions would reduce the possibility of exceeding the maximum prescribed dose, i.e. a special treatment method which can be only used in psychiatric hospitals following a procedure stipulated by the law. In its response to the preliminary report, the retirement home stated that this had been resolved, and that the general practitioner and psychiatrist had been informed of the necessity to limit drug therapy. • I n light of the expert’s findings during the visit to Ljutomer Retirement Home, the NPM recommended that when prescribing additional drugs (“when necessary”), the maximum allowed daily dose should be additionally stated (once or several times a day). With simultaneous use of drugs which might prolong the QT interval, ECG monitoring should be performed. The instructions for administering drugs “when necessary” should also be provided in electronic format in a manner understandable to healthcare personnel. In its response to the preliminary report, the retirement home stated that the drugs prescribed by the doctor to be used “when necessary” are, when administered, recorded in the computer programe in the prepared form (drug administration). The retirement home agrees that doctors should be warned about consistently recording drugs (whereby they should state how often or every how many hours the drug should be administered when necessary) and has informed the doctor of our recommendation. •D  uring its visit to Idrija Retirement Home, the NPM recommended that doctors prescribing drugs to be used when necessary be warned of the fact that the drug therapy must be defined in terms of time. IMPLEMENTATION OF THE DUTIES AND POWERS OF THE NPM IN 2017 NATIONAL PREVENTIVE MECHANISM UNDER THE OPTIONAL PROTOCOL TO THE UN CONVENTION AGAINST TORTURE AND OTHER CRUEL, INHUMAN OR DEGRADING TREATMENT OR PUNISHMENT 51