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

Abstract

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<0.001, 95% CI 0.63 to 0.87), and 0.80 (p<0.001, 95% CI 0.71 to 0.89) in identifying SODF medications appropriate for modification, suggesting substantial inter-rater agreement. Overall accuracy of each pharmacist’s ratings was high, ranging from 93.7% to 95.6%.ConclusionsThe implicit INGEST algorithm has potential for use by clinicians in nursing home and hospital settings for determining suitability of SODF medications for modification. Further studies should be conducted to assess its external validity and utilisation in daily practice for improving clinical outcomes for patients with SODF dysphagia.

Adult Patients with Difficulty Swallowing Oral Dosage Forms: A Systematic Review of the Quantitative Literature

“…In these guidelines, there is more emphasis on SODF manipulation for administration via EFT [42] than SODF manipulation for administration to patients with swallowing difficulties without an EFT. This challenge has been recognised and a novel implicit tool, Inappropriate solid oral dosaGE form modification aSsessmenT (INGEST), has been developed [43]. This may serve to assist clinicians in determining suitability for the modification of SODFs and may help to reduce MAE.…”

A Pilot Study on Pharmacists’ Knowledge, Attitudes and Practices towards Medication Dysphagia via Asynchronous Online Focus Group Discussion

“…This points to the necessity to make references and information resources on the suitability of SODF modification available to their everyday practice. For pharmacists working in resource-constrained institutions, the INGEST algorithm [65] can be used as an alternative tool to guide them in making such evaluations. Being an implicit tool, it prompts users to consider attributes of SODFs and patients' need for tube-feeding before determining their suitability for DFM [65].…”

“…For pharmacists working in resource-constrained institutions, the INGEST algorithm [65] can be used as an alternative tool to guide them in making such evaluations. Being an implicit tool, it prompts users to consider attributes of SODFs and patients' need for tube-feeding before determining their suitability for DFM [65]. Secondly, there appeared to be a lack of formal communication channel for conveying information on patients' swallowing ability and/or needs for DFM.…”