L’écrasement des médicaments en gériatrie : une pratique « artisanale » avec de fréquentes erreurs qui nécessitait des recommandations

Caussin, M.; Mourier, W.; Philippe, Sandrine; Capet, C.; Adam, M.; Reynero, N.; Jouini, C.; Colombier, Aline; Kadri, K.; Landrin, I; Gréboval, E.; Rémy, É.; Marc, F.; Touflet, M.; Wirotius, F.; Delabre, N.; Hiress, C. Le; Rorteau, V.; Vimard, M.; Dufour, Marie; Tharasse, Christine; Diệu, Bùi Thị Huyền; Varin, Rémi; Doucet, J.

doi:10.1016/j.revmed.2012.05.014

Cited by 39 publications

(22 citation statements)

References 7 publications

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“…Overall improvement of practices The first survey was conducted when there was a lack of information on all the problems encountered by crushing medications, and in the absence of suitable standards regarding the procedure to be followed when difficulties exist in the administration of oral medications in elderly patients [15]. The second survey demonstrated a significant improvement in practices, which we attribute to the awareness of the medical personnel and caregivers and to the drafting and circulation of validated recommendations, disseminated regionally and nationally [18,19].…”

Section: Discussionmentioning

confidence: 99%

“…For example, it has been shown that the digestive absorption of powdered levothyroxine is better than that of its tablet formulation [11]. In 2009, we conducted the first prospective, multidisciplinary (including doctors, pharmacists and nurses) study involving all beds in the geriatric units of our University Hospital Centre, with the aim of analysing the prescription, preparation and administration of crushed medications [15]. allergic reactions, inhalation of medication particles).…”

Section: Fundamental and Clinicalmentioning

confidence: 99%

“…Few studies have been carried out on this topic, and those that exist generally did not take into account the entire procedure from prescription to administration [12][13][14]. In 2009, we conducted the first prospective, multidisciplinary (including doctors, pharmacists and nurses) study involving all beds in the geriatric units of our University Hospital Centre, with the aim of analysing the prescription, preparation and administration of crushed medications [15]. It exposed many practice flaws and errors in the absence of suitable standards.…”

Section: Introductionmentioning

confidence: 99%

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

Bourdenet

Giraud

Artur

et al. 2015

Fundamemntal Clinical Pharma

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Fundamental and Clinicalmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Bourdenet

Giraud

Artur

et al. 2015

Fundamemntal Clinical Pharma

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“…The prevalence of poly-pharmacy and food-drug interaction is extremely high in the nursing care, due to crush pills or open capsules so that patients presenting problems swallowing and/or behavior issues may take the medicines more easily [2,8]. These practices, marked by frequent errors, increased drug interaction risks as well as adverse effects and even could lead to toxic effects for both patients and caregivers [9]. Based on the finding suggests of this study that nursing should receive more guidance in using strategies to prevent several interactions during the nursing care in dysphagia patients.…”

Section: Discussionmentioning

confidence: 99%

Oral Administration of Poly-pharmacy in Institutionalized Elderly Patients with Dysphagia

F¹,

Oliveira²

2019

J Aging Sci

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Background: Poly-pharmacy in older people is a major concern in nursing home residents. Different factors can modify oral medications status like swallowing difficulties. Objective: The aim of this study was to describe the drug-food interactions in institutionalized elderly with dysphagia. Methods: A descriptive, cross-sectional study was conducted with individualized data for 16 institutionalized older people ≥ 65 years of both sexes (13 women, 3 men) from the Curitiba of Paraná State, Brazil. Data were collected from medical prescriptions and patients medical records. The prescriptions were analyzed for the potential drug interactions using the ATC (Anatomic Therapeutic Chemical) classification proposed by the World Health Organization. Verbal or written informed consent was obtained from all participants. Results: A total of 16 patients were included in the study, among them 12.5% were males and 87.5% were females. 12 prescriptions were examined with 171 molecules of drug orally. The most frequently used drugs were antipsychotic and anticonvulsant (87.5%), antihypertensive (81.25%), cardiovascular system drugs (75%) and gastrointestinal tract drugs (62.5%). The potential of food-drug interaction was seen in the prescriptions of elderly patients related to Alzheimer's. Conclusion: Cognitive impairment and use of poly-pharmacy increased the risk of toxic effects in dysphagia patients. Future studies to reduce poly-pharmacy and improve pharmacological appropriateness may facilitate the understanding of pharmacodynamic and pharmacokinetic effects caused by drugs.

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“…Concerning the administration of drugs in the elderly, as mentioned by Caussin et al (Caussin et al 2012), there is an enormous potential for improvement in drugs safety and effectiveness. In geriatrics, it is frequent to crush pills or simply open capsules so that patients presenting problems swallowing and/or behavior issues may take the medicines more easily.…”

Section: Discussionmentioning

confidence: 99%

Medication in nursing homes in Alsace: a preferential list of drugs obtained by consensus

et al. 2014

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In order to improve patient care, OMEDIT (Observatory of drugs, medical devices and therapeutic innovation) Alsace, conducted a study to develop a Preferential list of Drugs adapted to the Elderly (PDE list) in nursing homes. The study conducted from December 2011 to June 2012 was organized in 4 phases: 1) creation of a preliminary list of drugs from those currently used in nursing homes in Alsace, 2) application of a two-round Delphi process to evaluate the preliminary list involving mobilization of experts from different backgrounds (geriatricians, general practitioners, pharmacists …), 3) identification of molecules considered in literature as potentially inappropriate, 4) generation of a final PDE list, including information concerning proper use of drugs for prescription and administration. 53 experts participated in the study. In the first round, 338 drugs were on the preliminary list, 246 were considered as appropriate by experts and 28 as inappropriate. 64 drugs without consensus were submitted to a second round. 32 of them were considered as inappropriate and 32 others remained on the list with no consensus. These last 32 were evaluated by OMEDIT and 3 were considered as appropriate drugs for the elderly. Totally, 252 drugs constitute the final PDE list from our study. The PDE list constitutes a new guide for optimization of both prescription and administration of drugs in nursing homes and could help reduce misuses and poly-medication, which are constant preoccupations to avoid adverse drug reactions in elderly.Key points● The study was carried out with the aim to create a Preferential list of Drugs adapted to the Elderly (PDE list) in nursing homes using a modified Delphi method.● The PDE list constitutes a new guideline to harmonize practices in nursing homes and to help physicians and nurses to achieve best possible care management.

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L’écrasement des médicaments en gériatrie : une pratique « artisanale » avec de fréquentes erreurs qui nécessitait des recommandations

Cited by 39 publications

References 7 publications

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

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

Oral Administration of Poly-pharmacy in Institutionalized Elderly Patients with Dysphagia

Medication in nursing homes in Alsace: a preferential list of drugs obtained by consensus

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