Preparing and administering medications via enteral feeding tubes: a guideline for clinical pharmacists and multi-professional team

Abstract

Objective: To identify the most prescribed drugs by enteral feeding tube in a public hospital and to a guideline for safe medication preparation and administration via enteral feeding tubes. Methods: A cross-sectional study with analysis of the daily prescriptions of patients exclusively using an enteral catheter in intensive care units and inpatients of the medical clinic specialty, in which descriptive statistics were used to identify the prevalence of medication use by tube. In a second step, a protocol was developed for the situation in which oral medications are prescribed to patients with a tube in the digestive tract. Results: A total of 1.810 medications prescribed by enteral feeding tube, of these 1.810, 291 (16%) were prescribed in liquid pharmaceutical form (suspension, solution, syrup) e 1.519 (84%) were prescribed in solid pharmaceutical form (tablets, capsule). 52 medications were selected for the protocol, and 14 of them (26.9%) with the recommendation of not crushing and administering via enteral feeding tube. Conclusion: Our results highlights the performance of clinical pharmacist in monitoring patients with enteral feeding tubes and guidance of multi-professional team. The protocol elaboration will guide for preparation and administration medication through the enteral feeding tube, reducing possible adverse events and ensuring the safety and efficacy of drug therapy.

Atuação do farmacêutico clínico no uso de medicamentos por via sondas enterais em terapia intensiva

“…Pharmacists should work in collaboration with the multiprofessional team in the identification of potential drug-diet interactions in order to assist in the management regarding use of such medications 4,31,32 . In this study, the guidelines on drugdiet interactions and pause in the diet were related to 80% and 75% of the medications, respectively.…”

“…In this sense, the pharmaceutical care lines should meet each patient's needs, given the specificities of the treatment. Thus, in patients whose oral route cannot be used, enteral access devices are also employed for drug administration, concomitantly with nutrients 3,4 . The medications can be either in solid (tablets, powders and capsules) or in liquid (solutions and suspensions) pharmaceutical forms 4 .…”

“…Thus, in patients whose oral route cannot be used, enteral access devices are also employed for drug administration, concomitantly with nutrients 3,4 . The medications can be either in solid (tablets, powders and capsules) or in liquid (solutions and suspensions) pharmaceutical forms 4 . Considering the complexity of drug administration through these devices, using appropriate techniques helps to minimize problems related to tube obstruction, to reduced therapeutic efficacy, and to increased drug toxicity and drug-diet interactions 4 .…”

“…Teamwork is fundamental and important in all the stages of patient's progression [3][4][5][6] . Among the essential professionals for the patient's nutritional support is the pharmacist, providing diverse information on appropriate nutritional formulations and their proper handling, including co-administration of medications [4][5][6] .…”

“…Teamwork is fundamental and important in all the stages of patient's progression [3][4][5][6] . Among the essential professionals for the patient's nutritional support is the pharmacist, providing diverse information on appropriate nutritional formulations and their proper handling, including co-administration of medications [4][5][6] . Thus, the objective of this study was to evaluate the pharmaceutical interventions and guidelines related to medication use via enteral tubes in the Intensive Care Unit (ICU).…”