Assessment of clinical practices for crushing medication in geriatric units

• Published in: The Journal of nutrition, health & aging health & aging, 2017-10, Vol.21 (8), p.904-908
• Main Authors: Fodil, M., Nghiem, D., Colas, M., Bourry, S., Poisson-Salomon, A.-S., Rezigue, H., Trivalle, Christophe
• Format: Article
• Language: English
• Subjects: Aged; Aging; Best practice; Capsules - administration & dosage; Deglutition Disorders - complications; Drug administration; Dysphagia; Female; Geriatrics; Geriatrics/Gerontology; Humans; Inpatient care; Male; Medicine; Medicine & Public Health; Neurosciences; Nutrition; Older people; Pharmaceutical Preparations - administration & dosage; Primary Care Medicine; Quality of Life Research; Quantitative analysis; Tablets - administration & dosage
• ISSN: 1279-7707; 1760-4788
• DOI: 10.1007/s12603-017-0886-3

Objectives To assess the modification of the form of medication and evaluate staff observance of good clinical practices Design One-day assessment of clinical practices. Setting 17 geriatrics units in the 3 Teaching Hospitals of Paris-Sud (APHP), France. Participants Elderly in-patients with difficulties swallowing capsules and tablets. Measurements Assessment of target-patient prescriptions and direct observation of nurses’ medical rounds. Results 155/526 in-patients (29.5%) were unable to swallow tablets or capsules: 98 (40.3%) in long-term care, 46 patients (23.8%) in the rehabilitation unit and 11 (12.2%) in the acute care unit (p = .005). In thirty-nine (27.3%) of the 143 prescriptions studied all tablets were safe to crush and all capsules were safe to open. In 104 cases, at least one medication could not be safely modified, including 26 cases (18.2%) in which none of the prescribed drugs were safe to crush or open. In 48.2% of the 110 medications that were crushed, crushing was forbidden, and presented a potential threat in 12.7% of cases or a reduced efficacy in 8.2% of cases. Crushing methods were rarely appropriate: no specific protective equipment was used (81.8%), crushing equipment was shared between patients without cleaning (95.1%), medications were spilled or lost (69.9%). The method of administration was appropriate (water, jellified water) in 25% of the cases, questionable (soup, coffee, compote, juice, cream) in 55% of the cases and unacceptable (laxative) in 21% of the cases. Conclusion Management of drug prescriptions in patients with swallowing difficulties is not optimal, and may even have iatrogenic effects. In this study, 12.7% of the modifications of the drug form could have been harmful. Doctors, pharmacists and nurses need to reevaluate their practices.