[not now]

Originally Posted by earle58

i think i know what you're talking about.
doesn't that pill easily crumble?
and wouldn't that be crushable?
i'm thinking of the yellow pillow that's enteric-coated, which should be obvious to any nurse that it's non-crushable.

and this nurse worked in icu?????

I know what pill you're talking about. Many of my confused geriatric residents would try to bite it regardless of how many times I asked them to "Please don't bite this pill..." and it would crumble in thier mouth. Then they would spit it out. Frustrating to say the least. We could often get the order changed to two 10meq instead of one 20meq which is slightly easier to swallow. Or liquid which from what I gather doesn't taste very well. I'd usually say "Take it like a shot of whiskey and here's your apple juice chaser." Or just mix it with juice and make sure they drank the entire thing.

I believe powder or liquid KCL is it's not sustained release like the pills are. But if the nurse is crushing pills, neither are they. If the patient is recieving bolus NG feeding the KCL liquid has to be timed to right before the feeding since the liquid can cause GI irritation.

Either way the nurse should have asked to have the order changed.

My question is: What do you do when you notify the MD the med is not crushable and he still wants it given?

[sabRN2b05]

Originally Posted by chadash

I just love your posts~

I agree! Marie, you just tell it like it is!!! My kind of girl!!

[MS._Jen_RN]

[quote=My question is: What do you do when you notify the MD the med is not crushable and he still wants it given?[/QUOTE]
I would try to get Pharmacy in on the discussion if you have a problem with this. Depending on the potential rxn to the crushing I might refuse to give it. (ex- crushing Oxycontin, Depekote, Ambien CR)
I've seen this issue too much. The MD doen't stop to think about the right route for the patient so they order it PO by habit. Or they order it per tube and it's still a pill that can't be crushed. I know of times that it's been given anyway, usually by an RN who "didn't know" the pill couldn't be crushed.

K-Dur is a pill made up of little balls of med. The balls are then stuck togeter. It crumbles easily but those balls can't be crushed. Sometimes we get a generic as capsule with the balls inside.

The nurse who crushed this committed a med error (an knowingly did so). Her actions could have been detrimental to the patient depending on what she's crushing) This should be a reportable event. She, and probably some of the other staff need some education.

~Jen

[TiffyRN]

K-Dur will clog up a dobhoff solid as cement; guess how I know. Yes, I used to crush it before I was educated. It does not have the same release rate as other forms of oral potassium. This is one reason one must call an MD for an order change when there is an order for K-Dur through an enteral tube (or as more often is the case it is carried over from home meds).

Another one I didn't know about: Dilantin oral. The most common form of Dilantin pills are sustained release and are not to be automatically substituted with the liquid form, neither should they be opened (they are capsules). The MD will likely order the same # milligrams/day but might (should) order them spaced out through the day instead of at one dose a day. Besides those capsules send up this obnoxious tiny cloud of med that makes you cough. Yea, guess how I know that? There is a dilantin chewable tablet (50mg I think) that is obviously ok to crush since it's ok to chew.

Anyway, those are two meds that sometimes nurses don't know that must be reordered if a patient has an enteral tube.

[TazziRN]

Originally Posted by TiffyRN

K-Dur will clog up a dobhoff solid as cement; guess how I know. Yes, I used to crush it before I was educated. It does not have the same release rate as other forms of oral potassium. This is one reason one must call an MD for an order change when there is an order for K-Dur through an enteral tube (or as more often is the case it is carried over from home meds).

Another one I didn't know about: Dilantin oral. The most common form of Dilantin pills are sustained release and are not to be automatically substituted with the liquid form, neither should they be opened (they are capsules). The MD will likely order the same # milligrams/day but might (should) order them spaced out through the day instead of at one dose a day. Besides those capsules send up this obnoxious tiny cloud of med that makes you cough. Yea, guess how I know that? There is a dilantin chewable tablet (50mg I think) that is obviously ok to crush since it's ok to chew.

Anyway, those are two meds that sometimes nurses don't know that must be reordered if a patient has an enteral tube.

Nothing like learning from experience!!

[wooh]

Originally Posted by Marie_LPN

If the doctor order the pt. to be shoved out the window, is she going to do that too??

Depends on the patient....

[Zee_RN]

Originally Posted by wooh

Depends on the patient....

Hoot!! LOL!

[HappyNurse2005]

Well, it can be put in water and dissolved. I've done that several times and mixed teh crushed bit in applesauce (yeah, not doing it that way for the Jtube pt)

Our tube feeders usually get liquid kcl.

[bonesrn]

how do these idiots make it out of nursing school????

[SharonH, RN]

Originally Posted by HappyNurse2005

Well, it can be put in water and dissolved.

This is true. It cannot be crushed but it can be dissovled in water and given that way, perhaps that is how your co-worker gave it? Of course, it is easier to give the liquid form.