Survey of nurses’ knowledge and practice regarding medication administration using enteral tubes

Tillott, Harry; Barrett, Diane; Ruan, Jingjing; Li, Vincent; Merrick, Susan; Steed, Helen; Morrissey, Hana; Ball, Patrick

doi:10.1111/jocn.15498

Cited by 9 publications

(8 citation statements)

References 10 publications

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“…The multivariate logistic regression confirmed that MDEs independently increased the risk of obstruction and tube replacement. These results are consistent with those of other studies where crushed medication has been found to contribute to enteral tube obstruction 12 , 19 , 21 , 25 . Crushing gastro-resistant or modified-release medications could increase damage and tube obstruction rates because of adhesion of the enteric coating or formulation excipients, among others, to the tube walls 11 , 19 , 30 .…”

Section: Discussionsupporting

confidence: 93%

“…In addition to enteral nutrition, these patients often need simultaneous drug therapy, which is usually administered through tube feeding. Crushing oral dosage forms prior to enteral medication administration is common in clinical practice; however, reported practices are inconsistent and the correct administration remains a challenge 20 , 21 .…”

Section: Discussionmentioning

confidence: 99%

“…As opposed to aspirin, omeprazole modified-release capsules are associated with an increased risk of obstruction and tube replacement (OR 2.236; 95% CI 1.014–4.932). PPIs are commonly regarded as problematic drugs to administer via enteral tube 12 , 21 , 26 , 32 , 33 . The enteric-coated dosage forms of these drugs should be crushed and dissolved in 8.4% sodium bicarbonate 8 , 33 .…”

Section: Discussionmentioning

confidence: 99%

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Medication delivery errors in outpatients with percutaneous endoscopic gastrostomy: effect on tube feeding replacement

García González,

Martín-Suárez,

Salvador Sánchez

et al. 2023

Sci Rep

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Patients with enteral access usually receive oral drugs via feeding tubes and correct drug administration remains a challenge. The aim of this study was to identify common medication delivery errors (MDEs) in outpatients with percutaneous endoscopic gastrostomy (PEG) and evaluate their association with the need for tube replacement due to deterioration or clogging. A 2-year retrospective study that comprised adult outpatients with a placed/replaced PEG tube and whose electronic medical record included home medication was carried out. Treatment with medication that should not be crushed and administered through an enteral feeding tube was considered an MDE. We included 269 patients and 213 MDEs (20% of oral prescriptions) were detected in 159. Ninety-two percent of the medications associated with MDEs could be substituted by appropriate formulations. Tube replacement due to obstruction was needed in 85 patients. MDEs were associated with increased risk for tube replacement (OR 2.17; 95% CI 1.10–4.27). Omeprazole enteric-coated capsules were associated with the greatest risk (OR 2.24; 95% CI 1.01–4.93). PEG outpatients are highly exposed to MDEs, leading to a significant increase in the odds of tube replacement, mainly when treated with omeprazole. The use of appropriate alternative therapies would prevent unnecessary adverse events.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Medication delivery errors in outpatients with percutaneous endoscopic gastrostomy: effect on tube feeding replacement

García González,

Martín-Suárez,

Salvador Sánchez

et al. 2023

Sci Rep

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“…1,4,11 The evidence shows that without special training and support, doctors and nurses lack the knowledge to prescribe, prepare, and administer appropriate drug formulations. [12][13][14][15][16][17][18][19][20] The risks of administration via FTs are mainly related to FT occlusions and the loss of medication efficacy or an increase in toxicity because of wrong drug manipulation techniques. 1,4,6,19,21,22 In order to understand the dosage forms better, a necessity for pharmacists' involvement in these multi-professional decision-making teams is recognized.…”

Section: Introductionmentioning

confidence: 99%

“…The evidence shows that without special training and support, doctors and nurses lack the knowledge to prescribe, prepare, and administer appropriate drug formulations 12‐20 . The risks of administration via FTs are mainly related to FT occlusions and the loss of medication efficacy or an increase in toxicity because of wrong drug manipulation techniques 1,4,6,19,21,22 .…”

Section: Introductionmentioning

confidence: 99%

Solid oral medications' suitability for use in enteral feeding tubes

Teder

Jõhvik

Meos

et al. 2021

Nursing in Critical Care

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Background: There is a lack of specific data about the efficacy and safety of medications administered via feeding tubes, although there is a general awareness that not all drug formulations are suitable.Aims and objectives: To overview the current situation with solid medications administered through feeding tubes in the Tartu University Hospital intensive care units. To evaluate the availability of information on the suitability of drug formulations for administration via feeding tubes.Design: This was a descriptive retrospective document analysis study.Methods: During visits to the intensive care units, medication data for current patients were collected from paper medical charts and nurses. In addition, package information leaflets, summaries of product characteristics, and two practical handbooks were used for evaluating the medicines' suitability for administration via feeding tubes. A request for information was also sent to manufacturers or marketing authorization holders.Results: In 3 months, data were collected from 113 intensive care patients' medical charts. A total of 306 medication administrations via feeding tubes were documented and analysed, 67% of which were solid oral dosage forms. Exactly 91.2% of these were conventional tablets. After the analysis of information availability, 88% of the medications were classified as suitable for administration via feeding tubes, but only 48% had the manufacturer-provided information. Conclusion:This study showed that the information about the suitability of formulations administration through a feeding tube is not readily available for almost half of the medications. The manufacturers seem to have the relevant information, but it is not always added to their medications' official information, putting these patients at higher risk for errors.Relevance to Clinical Practice: This study shows that if there is no clear statement about administration through feeding tubes on official manufacturers' information,

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Crushed Tablet Administration for Patients with Dysphagia and Enteral Feeding: Challenges and Considerations

Blaszczyk,

Brandt,

Ashley

et al. 2023

Drugs Aging

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Dysphagia is increasingly common in older adults; it is especially prevalent in long-term care settings. Patients with dysphagia likely require pharmacologic treatment for multiple comorbidities but may find it difficult or impossible to swallow oral medications. Administering crushed medications mixed with a soft food or liquid vehicle, or via a feeding tube, is a common strategy to circumvent swallowing difficulties in patients with dysphagia. However, inappropriate medication use and improper crushing technique can reduce the medication dose a patient receives, alter medication pharmacokinetics and pharmacodynamics, and compromise treatment efficacy and patient safety. Clinical judgment is needed to identify medications that can and cannot be crushed, select a crushing methodology and vehicle for administering crushed medications, and create a strategy for administering multiple medications. A coordinated effort from the entire care team—including physicians, pharmacists, nurses, advanced practice providers, speech therapists, patients, and caregivers—is necessary to develop and implement an individualized plan for administering medications to patients with dysphagia. This review details the current literature regarding the administration of medications that have been altered, such as by crushing tablets or opening capsules, for patients with dysphagia or who are receiving enteral feeding and provides recommendations on best practices.

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Survey of nurses’ knowledge and practice regarding medication administration using enteral tubes

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 9 publications

References 10 publications

Medication delivery errors in outpatients with percutaneous endoscopic gastrostomy: effect on tube feeding replacement

Medication delivery errors in outpatients with percutaneous endoscopic gastrostomy: effect on tube feeding replacement

Solid oral medications' suitability for use in enteral feeding tubes

Crushed Tablet Administration for Patients with Dysphagia and Enteral Feeding: Challenges and Considerations

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