Safe Medication Swallowing in Dysphagia: A Collaborative Improvement Project

Abstract

Episodes of choking during medication administration to patients with dysphagia prompted a chart audit and caregiver interview to identify system problems that allowed inappropriate drug administration to occur. Sixty elderly patients residing on two patient care areas in a 500-bed complex continuing care facility were studied. The audit explored the actual nursing medication administration methods and compared this to the information obtained from various communication tools including instructions that appeared on the medication administration record (MAR), the current diet order, the recommendations of the speech-language pathologist (SLP) and comments on the nursing care plan. The audit yielded a number of discrepancies between nursing actions and the instructions obtain from these sources.We proposed that changes to the process of communicating medication swallowing recommendations among team members would lead to greater patient safety. Major practice changes included the use of standardized language by the SLP when making recommendations, the writing of SLP recommendations in the doctor's orders, the inclusion of SLP recommendations on the MAR and the creation of a "dysphagia alert" on the pharmacy computer system. An educational intervention was conducted to implement process changes. Its effectiveness was evaluated using a pre-and post-test and a participant satisfaction survey. A post-implementation audit showed compliance with the practice change.In summary, process changes were implemented to improve compliance with SLP medication-related swallowing recommendations and to prevent the inadvertent prescribing, dispensing or crushing of sustained-release medications in patients with dysphagia.

Recommandations en vue de la prévention des fractures dans les établissements de soins de longue durée

“…Les aînés fragiles qui courent un risque élevé de subir une fracture dans les établissements de soins de longue durée doivent aussi composer avec d'autres problèmes : en effet, plus de 40 % d'entre eux souffrent de démence 8 . une proportion semblable éprouve de la difficulté à avaler 9,10 . et plus de 20 % d'entre eux pourraient souffrir d'insuffisance rénale 11,12 .…”

Development, Characterization and Evaluation of Soft Oral Edible Gel Using Gellan Gum

“…The physical injury caused upon rubbing of the solid preparation against mucous membrane in the oral cavity can discomfort the patient [3]. The crushing of modified release tablets is undesirable, as this may lead to drug toxicity or loss of efficacy of the dosage form [4]. Carvedilol (CDL) is an oral, cardio selective β-receptor blocking agent, primarily used to treat hypertension [4].…”

“…The crushing of modified release tablets is undesirable, as this may lead to drug toxicity or loss of efficacy of the dosage form [4]. Carvedilol (CDL) is an oral, cardio selective β-receptor blocking agent, primarily used to treat hypertension [4]. It undergoes extensive first pass hepatic metabolism due to cytochrome P450 2D6 (CYP2D6) enzymes and its oral bioavailability is only 25-35%.…”

Formulation, characterization and in vivo evaluation of novel edible dosage form containing nebivolol HCl

“…The physical injury caused upon rubbing of the solid preparation against mucous membrane can discomfort the patient (Dixit, Parthasarathi, Hosakote, 2011). Crushing of enteric coated tablets or controlled release tablets is undesirable, as this may lead to loss of efficacy of the dosage form (Jackson et al, 2008).…”