Oral Medication Administration in Patients with Restrictions on Oral Intake—A Snapshot Survey

To, The-Phung; Story, David A; Booth, Jane; Nielsen, Fiona; Heland, Melodie; Hardidge, Andrew

doi:10.1002/j.2055-2335.2013.tb00249.x

Cited by 3 publications

(5 citation statements)

References 17 publications

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“…Written feedback or comments were from emails from over 100 staff, with at least 50 from nursing, 20 from medical, 30 from pharmacy, and 15 from other staff including speech language pathologists. Written feedback or comments were also taken from an in‐house survey (unpublished) of intravenous paracetamol use and a medication administration survey because these responses related to the management of oral medications when patients had restrictions on their oral intake. Data were also drawn from an in‐house snapshot audit (unpublished) of medication administration during the period of restriction on patients' oral intake before a surgical procedure.…”

Section: Methodsmentioning

confidence: 99%

Barriers to managing medications appropriately when patients have restrictions on oral intake

Brien

Story

2019

Evaluation Clinical Practice

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Rationale, aims, and objectives: Investigation of several serious adverse events in our organization highlighted that medications were managed inappropriately when patients have oral intake restrictions. The aim of this work was to identify the barriers to optimal medication management when patients have restrictions on their oral intake.Method: Data were feedback and comments obtained between 2011 and 2014 from a hospital-wide quality assurance project. Data had not been purposefully collected and were in response to a general request for feedback regarding managing oral medications when patients have oral intake restrictions. Data came from a range of clinical staff and from various forums associated with the quality assurance project, including 37 presentations, 34 group meetings, and over 50 one-on-one meetings, as well as emails and other sources.Data were analysed using the thematic analysis approach. Data were coded inductively, and the domains of the Theoretical Domains Framework were used to categorize the data. Subthemes and themes were then developed.Results: Barriers could be broadly grouped into systems-level issues (organizational guidance and work environment) and the individual person-level issues (staff knowledge and beliefs). These barriers highlight the complexity of the medication management task. The lack of standardized guidance and consistent terminology regarding medication administration when patients have restrictions on oral intake, particularly when fasting or nil by mouth, were important systems factors, as were workflow issues and the "culture" of the environment in which staff practiced. Lack of knowledge about medication administration, social influences, and role interpretation were important individual person factors. Conclusion:Systems-and individual person-level issues were significant contributors to inappropriate medication management when patients have oral intake restrictions. Many of the barriers may be addressed with systems approaches such as hospital-wide guidance that simplifies and standardize oral medication administration instructions, particularly regarding fasting and nil by mouth terminology.

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Section: Methodsmentioning

confidence: 99%

Barriers to managing medications appropriately when patients have restrictions on oral intake

Brien

Story

2019

Evaluation Clinical Practice

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“…Don't rush to crush: modifying oral medicines It has also been shown that knowledge and opinions about medication modification for this patient group vary widely, both across and within the same healthcare profession. [2][3][4][5] Previous studies have examined nursing, medical and pharmacists' approaches to medication modification and administration for these patients; however, this study compares practice directly with the recommendations in SHPA's DRTC Handbook, the current Australian guideline.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5] Alarmingly, it was shown in each of these studies that a rel-atively high number of healthcare professionals report cases of inappropriate medication modification and administration, including the crushing of sustained release medications. [2][3][4][5] In addition, medication administration to patients with swallowing difficulties is associated with higher error rates and therefore increased potential for harm, than administering medications to patients without swallowing problems. 6 There are a number of factors that could lead to patients being unable to swallow solid oral medicines in their original form, both physical and psychological.…”

Section: Introductionmentioning

confidence: 99%

“…A number of recent studies in Australia have established that healthcare professionals have a wide and varied range of opinions on how medications should be delivered to patients with swallowing difficulties and enteral tubes . Alarmingly, it was shown in each of these studies that a relatively high number of healthcare professionals report cases of inappropriate medication modification and administration, including the crushing of sustained release medications . In addition, medication administration to patients with swallowing difficulties is associated with higher error rates and therefore increased potential for harm, than administering medications to patients without swallowing problems …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Don't rush to crush: audit of modification to oral medicines for patients with swallowing difficulties

Downey

Thakerar

Kirsa

2015

Pharmacy Practice and Res

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Background Oral medicines are frequently modified prior to administration for patients with swallowing difficulties or enteral tubes. The current Australian guideline, the Don't Rush to Crush ( DRTC ) Handbook has been available since 2011, and this study compares practice with its recommendations. Aim To assess compliance with Australian guidelines for the preparation of medications in patients who are unable to swallow solid oral medicines, and to provide nursing education as necessary to improve practice. Method An observational audit was undertaken during morning medication rounds in an 18‐bed medical oncology ward over 4 weeks. For each occasion that an oral medicine was modified, the preparation method was assessed against recommendations in the DRTC Handbook for appropriateness. A number of education strategies were implemented with support and input from senior nursing staff focusing on medication modification for patients with fine‐bore nasogastric tubes. A re‐audit was undertaken to assess practice improvement. Results Education improved the proportion of medications prepared safely from 45% (37/82) to 91% (68/75) and those prepared according to the optimal method of preparation from 33% (27/82) to 60% (45/75). In the initial audit, 52% (43/82) of medications modified were strained prior to patient administration. Practical and collaborative education eliminated the straining of medications, and guidelines for difficult medications for patients with nasogastric tubes were developed. Conclusion Collaborative education that is practical and targeted can improve how oral medicines are modified for patients with swallowing difficulties and enteral tubes.

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Oral intake of solid medications in patients with post‐stroke dysphagia. A challenge for nurses?

Trapl‐Grundschober,

Schulz,

Sollereder

et al. 2024

Journal of Clinical Nursing

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AimTo provide a comprehensive overview of how stroke nurses manage solid medication (SM) delivery to patients with post‐stroke dysphagia.DesignCross‐sectional study.MethodsA self‐administered online survey was carried out among nurses in German‐speaking countries between September and December 2021.ResultsOut of a total of 754 responses, analysis was conducted on 195 nurses who reported working on a stroke unit. To identify swallowing difficulties in acute stroke care, 99 nurses indicated routinely administering standardised screenings, while 10 use unvalidated screenings, and 82 are waiting for a specialist evaluation. Regardless of whether screening methods are used or not, most preferred a non‐oral route of medication administration for patients with suspected dysphagia. None of the respondents reported administering whole SMs orally to patients. If screening methods indicate dysphagia, approximately half of the respondents would modify SMs. Participants who stated to use the Gugging Swallowing Screen managed the SM intake guided by its severity levels. One‐third of the group who awaited assessment by the dysphagia specialist provided modified medication before the consultation.ConclusionMost of the nurses on stroke units use swallowing screens and avoid the administration of whole SMs in post‐stroke dysphagia. In addition to the non‐oral administration, SMs are modified if dysphagia is suspected. Precise guidance on the administration of SM is needed, based on screening tests and prior to expert consultation.Trial and Protocol RegistrationClinicalTrials.gov: Registration ID: NCT05173051/ Protocol ID: 11TS003721.Implications for the profession and/or patient careThe present paper serves to alert nurses to the issue of patient safety when administering medication for acute stroke‐induced dysphagia.ImpactSM delivery after acute stroke‐induced dysphagia is often neglected. While nurses are aware of the risk associated with dysphagia and would not give whole SMs to patients, the modification of tablets and their administration with semisolids are common.Reporting MethodThis study was reported according to the Checklist for Reporting of Survey Studies (CROSS).

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Oral Medication Administration in Patients with Restrictions on Oral Intake—A Snapshot Survey

Cited by 3 publications

References 17 publications

Barriers to managing medications appropriately when patients have restrictions on oral intake

Barriers to managing medications appropriately when patients have restrictions on oral intake

Don't rush to crush: audit of modification to oral medicines for patients with swallowing difficulties

Oral intake of solid medications in patients with post‐stroke dysphagia. A challenge for nurses?

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