Assessment of clinical practices for crushing medication in geriatric units

Fodil, Mohammed Sadek; Nghiem, Duy; Colas, M.; Bourry, S.; Poisson-Salomon, A.-S.; Rezigue, H.; Trivalle, C.

doi:10.1007/s12603-017-0886-3

Cited by 30 publications

(50 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Crushing pills and opening capsules are very common procedures in elderly care, and powder from several different tablets is commonly mixed before being administered to a patient. There are no earlier reports on nurses' perceptions of the handling of these issues, but the findings presented here are similar to those obtained in earlier observational studies (12,23), interviews (21) and medication register analyses (23). Sustained release and enteric-coated pills are often crushed even when the summary of the product's characteristics recommends against this (12,22).…”

Section: Discussionsupporting

confidence: 82%

“…However, many elderly people suffer from dysphagia and thus find it difficult to swallow intact pills or capsules, so nurses commonly crush pills and tablets or open capsules to help patients ingest them more easily even though the medicine may be unsuitable for crushing or opening. . This constitutes an error in the preparation of medication.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Nurses’ self‐assessments of adherence to guidelines on safe medication preparation and administration in long‐term elderly care

Karttunen

Sneck

Jokelainen

et al. 2019

Scandinavian Caring Sciences

View full text Add to dashboard Cite

Background Medication‐related errors are common in elderly care. Most are detected during the preparation and administration stages of the medication process. Nursing staff have a key role in preventing errors, and it is based on adherence to guidelines. Aim The aim was to determine nursing staff's self‐assessments of how they adherence to guidelines on safe medication preparation, administration and asepsis in the medication process in long‐term elderly care and to identify factors affecting this adherence. Method Cross‐sectional study was conducted by total sampling at the communal long‐term elderly care wards of one healthcare district in Finland in November 2016. Data were collected from nursing staff by using a previously developed web‐based questionnaire. The response rate was 39.4% (n = 492). Results One‐third of the nurses stated that they do not always follow guidelines when preparing medication, and around a half deviate from them occasionally, when administering medication. The most serious deviation on preparation stage was crushing of sustained release and enteric‐coated tablets and mixing of crushed tablets together. On administration stage, the deviation of guidelines of giving medicine in recommended time or in relation to food was common. Associations were detected between the adherence to guidelines and the nurses’ experience about the adequacy of their knowledge of pharmacology and infection control, and their skill at performing medication calculations. Conclusion Deviation from guidelines often causes an error. There is a need to review the teaching of pharmacology, infection control and medication calculations during undergraduate and continuing education. In addition, nursing staff must be reminded about the ethical aspects of safe medication processes and the appropriate attitudes to these processes. Nurses must understand why it is important to follow guidelines when preparing and administering medications, in order to avoid errors.

show abstract

Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Nurses’ self‐assessments of adherence to guidelines on safe medication preparation and administration in long‐term elderly care

Karttunen

Sneck

Jokelainen

et al. 2019

Scandinavian Caring Sciences

View full text Add to dashboard Cite

show abstract

“…The 12.5% incidence of inappropriate modification was comparable with a similar Australian study in ACFs reporting a 17% rate of inappropriate modifications [19] but was lower than the incidence reported by another study in ACFs (32%) [17]. The inappropriateness of modifications was also lower compared to a study conducted in a hospital geriatric unit with 48.2% of dosage form modifications found to be inappropriate or contraindicated [32]. These discrepancies may be due to the different samples of facilities with different organisational/staffing characteristics, and variability in staff education levels and skills mix.…”

Section: Discussionsupporting

confidence: 69%

Appropriateness of oral dosage form modification for aged care residents: a video-recorded observational study

et al. 2020

View full text Add to dashboard Cite

Background Dosage forms of oral medications are frequently modified in aged care facilities (ACFs) by crushing/splitting tablets or opening capsules to facilitate medication administration for residents with swallowing difficulties. These practices pose safety concerns including the risk of adverse events resulting from loss of dose during transfer and alteration in the rate of absorption. Objective To identify the incidence, methods, and appropriateness of oral dosage form (ODF) modification practices in ACFs. Setting A purposive sample of four urban and regional ACFs in Queensland, Australia. Method The processes of ODF modification were observed and video-recorded using an action camera placed on medication trolleys. Each video was then reviewed, and the details of the medication modification processes were recorded in a data collection form. The appropriateness of the practices of dosage form modification was evaluated against existing national guideline (Australian Don't Rush to Crush Handbook). Deviations from the instructions in the guideline were considered as inappropriate practice. Main outcome measure Incidence and characteristics of inappropriate ODF modification. Results ODFs were modified in 25.7% of 810 observed medications. The most common methods of dosage form modification included crushing tablets with a manual crushing device (71.6%), cutting/splitting tablets (20.2%), and opening capsules (4.3%). According to the national guideline, 12.5% of the modification instances were inappropriate.Inappropriate practices were commonly associated with the suboptimal methods of medication preparation where medications were unsuitably modified, mixed, spilled, or incompletely dosed. Conclusion ODF modification is a common practice in ACFs. However, some of these modifications do not comply with the requirements of good practice in existing guidelines. Healthcare workers in ACFs need to be supported and upskilled with effective training to promote the best and safest practices of ODF modification.

show abstract

“…This practice was ascribed to nurses’ lack of knowledge about how to administer medication . This type of administration error has also been reported in hospitals . Lists about the appropriateness of crushing or suspending oral dosage forms can be found on hospital wards, but the correctness of these lists has been found to vary 67.7%‐92.0% …”

Section: Discussionmentioning

confidence: 99%

Mandatory medication content in the curricula of six health care personnel types with patient contact in Denmark

Druedahl

Hansen

Freese

et al. 2018

Basic Clin Pharma Tox

View full text Add to dashboard Cite

Medication use is a complex process involving different types of health care personnel. This study investigated and compared mandatory medication content in the curricula of six types of health care personnel with patient contact. Using content analysis, three independent raters analysed the mandatory medication content for physicians, pharmacists, pharmaconomists, nurses, health care assistants and support workers in the Capital Region of Denmark. Three dimensions were analysed as follows: communication with patients about medication, medication use or pharmacology and medication formulation and production. ECTS credits were totalled for courses analysed to have high or medium content, and inter-rater reliability was tested with Fleiss' kappa. The total mandatory medication content for pharmacists was 197.0 ECTS, physicians 136.0 ECTS, pharmaconomists 123.3 ECTS, nurses 52.0 ECTS, health care assistants 17.8 ECTS and support workers 0.0 ECTS. Communication with patients about medication was included to the greatest extent in the educations of pharmaconomists (112.0 ECTS), pharmacists (37.5 ECTS) and physicians (25.0 ECTS). Knowledge about medication use and pharmacology was taught primarily to pharmacists (146.5 ECTS), physicians (123.6 ECTS) and pharmaconomists (89.8 ECTS) and to a lesser extent nurses (52.0 ECTS), health care assistants (17.8 ECTS) and support workers (0.0 ECTS). Medication formulation and production were taught only to pharmacists (93.0 ECTS) and pharmaconomists (25.1 ECTS). Mapping the basic competencies about medication taught to each of the six health care personnel types can lead to a better understanding of how they can complement each other in patient care. The study points to weaknesses in medication curriculum content for health care personnel with the most patient contact. K E Y W O R D S curriculum, Denmark, education, health care, medication

show abstract

Assessment of clinical practices for crushing medication in geriatric units

Abstract: 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.

Cited by 30 publications

References 14 publications

Nurses’ self‐assessments of adherence to guidelines on safe medication preparation and administration in long‐term elderly care

Nurses’ self‐assessments of adherence to guidelines on safe medication preparation and administration in long‐term elderly care

Appropriateness of oral dosage form modification for aged care residents: a video-recorded observational study

Mandatory medication content in the curricula of six health care personnel types with patient contact in Denmark

Contact Info

Product

Resources

About