Development and validation of the INappropriate solid oral dosaGE form modification aSsessmenT (INGEST) Algorithm using data of patients with medication dysphagia from a neurology ward and nursing home in Singapore

ObjectivesThis study aims to develop and validate a novel implicit tool to assist clinicians in resource-limited settings to promptly assess suitability for modification of solid oral dosage forms (SODFs) during medication prescribing, review and/or administration for patients with dysphagia.DesignL...

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Bibliographic Details
Published in:BMJ open 2022-09, Vol.12 (9), p.e061774-e061774
Main Authors: Tan, Poh Leng, Chung, Wing Lam, Sklar, Grant E, Yap, Kai Zhen, Chan, Sui Yung
Format: Article
Language:English
Subjects:
Accuracy
Adult palliative care
Adverse events
Algorithms
Caregivers
Drug dosages
Drug stores
Dysphagia
GERIATRIC MEDICINE
Handbooks
Health & safety
Neurology
Nursing homes
Patient safety
Pharmacology and Therapeutics
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Summary:ObjectivesThis study aims to develop and validate a novel implicit tool to assist clinicians in resource-limited settings to promptly assess suitability for modification of solid oral dosage forms (SODFs) during medication prescribing, review and/or administration for patients with dysphagia.DesignLiterature review and a group discussion were conducted to elicit items for the construction of the INappropriate solid oral dosaGE form modification aSsessmenT (INGEST) algorithm. For its validation, inter-rater reliability among three independent users was evaluated. Accuracy of users’ ratings was also evaluated against the screening results using the Don’t Rush to Crush handbook.Setting and participantsThree pharmacists were involved in the development and another three were involved in the validation of the INGEST algorithm using anonymised medication records of 50 patients in a nursing home and a hospital ward; only SODFs that were modified prior to administration were evaluated.ResultsFollowing literature review, considerations included by consensus in the INGEST algorithm were the presence of special coating or modified release characteristics of the SODF medications, hazardous nature and taste of the active ingredients, manufacturer’s advice and use of tube feeding. Of the 381 SODF medications evaluated, 26 (6.8%) were identified by at least one pharmacist to be inappropriate for modification. Gwet’s AC among the three pharmacists in identifying SODF medications inappropriate for modification was 0.75 (p
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2022-061774