Medication incidents related to feeding tube: A cross-sectional study

Abstract

The aim is to evaluate the medication incidents relating to incorrect oral medication preparation and administration through enteral feeding tubes in hospitalized patients. A cross-sectional design was used to observe 374 doses of medications at three Brazilian hospitals. The patients consisted mostly of females (48.6%), elderly (65.71%), using polyurethane tubes (82.9%), with jejunal access (82.9%), and circulatory system diseases (45.71%). The most common medication incidents identified were: mixing tablets with other drug(s) (43.5%) and not labelling the prepared medication (60.4%). With regards to incorrect medication administration, not flushing the tube between medications (86.5%) and administering medications together (65.6%) were the most common errors. Tube obstruction was identified in 36.5% of doses administered. There was an association between tube obstruction and mixing tablet with other drug(s); tablet incorrectly reconstituted; tube not flushed prior to medication administration; tube not properly flushed between medications; concurrent administration of a medication and enteral formula; and enteral feeding not interrupted prior to medication administration. The results contribute to the development of knowledge in order to improve hospital nursing practice, especially in developing countries. Future studies should be conducted in order to access patients' outcomes related to incorrect oral medication preparation and administration through feeding tubes.

Factors associated with mechanical device-related complications in tube fed patients: A multicenter prospective cohort study

“…Furthermore, 38.7% were confused at the time of the AE. Another common cause of inadvertent feeding tube removal is tube obstruction [7,32,33]. In this study, this event was responsible for 13.1% of all NGT/NET-related AEs.…”

“…According to the literature, the rates related to tube obstruction vary from 12.5 to 45.0%. The event may be caused by mixing different medications together, failure to crush simple compressed tablets to a fine powder, failure to administer each medication separately, failure to wash the tube with at least 15 ml of water before and after medication administration, and failure to pause the enteral nutrition during medication administration [7,33,34]. Some interventions are proposed to reduce the risk of tube obstruction and include: policies and procedures to ensure safe practices by healthcare teams; review by a pharmacist of each medication order to determine whether the enterally administered medication will be safe; and the institution and following of nursing policies and procedures to safely prepare and administer medications [7].…”

Evaluation of prescription containing medication via enteral feeding tubes in an adult emergency unit

“…Tube obstruction is a frequent complication that can be caused by inadequate preparation of drugs for administration, in addition to contraindications related to pharmaceutical formulations. 3 A retrospective study analyzed that 34.7% of the medications prescribed by enteral route could have been replaced to reduce the risk of tube obstruction. 20 The pharmaceutical interventions performed in this scenario are extremely important considering the implications that can be caused by the non-recommendation of administration, ensuring the correct selection of pharmaceutical forms and the most adequate route of administration.…”

“…It can occur due to the viscosity and pH of the solution formed after crushing, to the excipients of the medication, to the non-pause of enteral nutrition before the administration of medications, to the mixture of various crushed oral solids for administration or to the improper hygiene of the tube before and after administration. 3 The reinsertion of a new tube implies discomfort for the patient, in addition to additional costs with materials and radiological exams to confirm its position. 4 Some solid oral medications have a highly technical formulation matrix, produced to guarantee a controlled release time in the organism.…”

Impact of a quality improvement programme on the preparation and administration of medications via a nasoenteral feeding tube: 2014–2019 intervention study

“…In a survey conducted in 2014 across three Brazilian hospitals, errors were identified in the preparation and administration of medications via nasoenteral tubes. One of these institutions was selected for a QIP to address these issues (baseline—2014) 7. Between 2015 and 2017,8 9 PDSA cycles were conducted to evaluate the processes.…”