Impact of recommendations on crushing medications in geriatrics: from prescription to administration

Abstract

The practice of crushing drugs is very common in geriatric units. In 2009 a first study, performed in all geriatric units of a university hospital, showed that numerous errors were made during prescription, preparation and administration. The aim of this second prospective study was to assess the impact of regional and national recommendations in the same geriatric units. A survey of 719 patients (85.3 ± 6.7 years) was performed in 2013. For each patient who received crushed drugs, we recorded the reason the drugs were crushed, pharmacological classes, galenic presentations and the technique used for preparation and administration. Results were compared to the previous study. The number of patients receiving drugs after crushing was significantly lower than in the previous study (22.9% vs. 32.3%, P < 0.001). The number of crushed drugs was lower too (594 per 165 patients vs. 966 per 224 patients (P < 0.01). The main indication for crushing drugs remained swallowing disorders. The dosage form prevented crushing in 24.9% of drugs (vs. 42.0% in 2009, P < 0.001), but the drugs generally remained crushed all together. A mortar was used less often (38.6% vs. 92.6%, P < 0.001), with preference for individual-specific cups (56.1%). Mortars were more often cleaned between each patient (56.0% vs. 11.6%). The vehicle was more often neutral (water 88.5% vs. 5.7%, P < 0.001). This second study shows that regional and national recommendations have led to an overall improvement of practices for crushing drugs. Technical improvements are still possible, in association with appropriate pharmacological studies.

Modification of oral dosage forms for the older adult: An Irish prevalence study

“…In accordance with previous literature (Bourdenet et al, 2015;Stubbs et al, 2008), medicines affecting the CNS were modified most frequently, followed by drugs acting on the Cardiovascular System, which indicates that these commonly prescribed medication classes, do not meet the needs of older patients and further research investigating this is necessary.…”

“…pharmacokinetic and pharmacodynamic changes (Mc Gillicuddy et al, 2015;Stegemann et al, 2010;Stegemann et al, 2012). Other studies have found that modifications may also arise due to the culture within the institution including prescribing, dispensing and administration practices and communication and multi-disciplinary team engagement (Bourdenet et al, 2015;Hanssens et al, 2006;Kelly et al, 2011a). Alternatives to ODF modification recommended in the best practice guidelines include unlicensed formulations or alternative medicines (Wright et al, 2006).…”

Swallowing Tablets and Capsules Increases the Risk of Penetration and Aspiration in Patients with Stroke-Induced Dysphagia

“…Our study revealed that crushing could have been avoided in nearly half of the patients who received their tablets crushed because they swallowed the placebos without having difficulties during laryngoscopy. This appears particularly relevant because crushing was inadequate in about 20 % of all modified drugs (alarmingly, this seems to be rather common as reported by other authors [18,42,43]), and therefore patients were put at an increased risk of overdosage or treatment failure. Furthermore, all of these drugs could have been either suspended instead of being crushed or replaced by pharmaceutically or therapeutically equivalent dosage forms for which crushing or suspending is permitted.…”

Good practice guidance to support safe oral medication preparation and administration through feeding tubes

“…After implementation of system improvements, there was reduction of nonconformities to 70%, especially regarding the crushing of enteric coated pills. They also found that, after utilizing the good practice Thus, it was observed that recommendations of the guide contributed to improvements in the care practice of elderly patients (Goedecke et al, 2016) (Bourdenet et al, 2015).…”