Administering Capsules

Specialties Geriatric

Published

Nurses:

I need your help! I am a brand new nurse and just started a job at a nursing home. I have a question regarding the administration of a capsule medication to those who cannot swallow pills.

As those of you who work with the elderly, or children know, patients cannot always swallow their pills easily and must have the medications crushed in applesauce. However, some of these medications come in a capsule which cannot be crushed. As a new nurse I am following the advice of the other nurses on the floor who have suggested that I crush what I can and then mix whatever I can't in with applesauce. However, I am concerned that this may not be the best option. What other method is there? Can the capsule be opened and the contents emptied into the applesauce or is trying to get the patient to swallow the capsule really the best option?

Any suggestions would be greatly appreciated. I am a new nurse and I want to do the right thing!

Thanks in advance!

When in doubt....ALWAYS go to the person in the know!!!! Call the pharmacist...That's what he is trained to do ...Answer these types of questions and concerns...:yeah:

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Specializes in Surgery, Tele, OB, Peds,ED-True Float RN.

There are even some ER and SR caps that CAN be opened. The granules themselves inside the capsule are formulated for extended release. For example Effexor XR can be opened and sprinkled on a small amt of baby food or apple sauce. This was taken from drugs.com:

"Effexor XR should be administered in a single dose with food either in the morning or in the evening at approximately the same time each day. Each capsule should be swallowed whole with fluid and not divided, crushed, chewed, or placed in water, or it may be administered by carefully opening the capsule and sprinkling the entire contents on a spoonful of applesauce. This drug/food mixture should be swallowed immediately without chewing and followed with a glass of water to ensure complete swallowing of the pellets."

So the answer is yes and no. People that open every cap are lazy and so are the people that won't open any! It's all about taking some time and doing the research! Most drug guides and the drug's website usually have a section for dosage and administration, also a section for warnings. That's where you'd usually find the answer! GREAT QUESTION!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
There are even some ER and SR caps that CAN be opened. The granules themselves inside the capsule are formulated for extended release. For example Effexor XR can be opened and sprinkled on a small amt of baby food or apple sauce. This was taken from drugs.com:

"Effexor XR should be administered in a single dose with food either in the morning or in the evening at approximately the same time each day. Each capsule should be swallowed whole with fluid and not divided, crushed, chewed, or placed in water, or it may be administered by carefully opening the capsule and sprinkling the entire contents on a spoonful of applesauce. This drug/food mixture should be swallowed immediately without chewing and followed with a glass of water to ensure complete swallowing of the pellets."

So the answer is yes and no. People that open every cap are lazy and so are the people that won't open any! It's all about taking some time and doing the research! Most drug guides and the drug's website usually have a section for dosage and administration, also a section for warnings. That's where you'd usually find the answer! GREAT QUESTION!

Well said......always check with pharmacy.

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I would clear it with the doctor and ask for authorization to open capsules and mix them with pudding or AS. If the patient is taking it at meal time wouldn't that fact in itself slow down absorption?

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Specializes in Surgery, Tele, OB, Peds,ED-True Float RN.
I would clear it with the doctor and ask for authorization to open capsules and mix them with pudding or AS. If the patient is taking it at meal time wouldn't that fact in itself slow down absorption?

Our Doc's would not appreciate that question! I can here the response now, "Your a nurse, with a brain... do some research and figure it out!" Even if he says, "Yes, you can open it," that doesn't mean that you CAN open it! If the pt experiences some sort of harm because you opened the capsule, your license would not be saved by saying, "Well the Doctor said I could..." Besides, if we had to call our doc's for every little question, we wouldn't be long in our job! Like I said before, many can be opened and many cannot... just takes a little research to find the answer!

As for taking medications with food, the absorption can be increased or decreased depending on the drug (and the food).

"Food can decrease a drug's rate of absorption and/or decrease the extent of absorption of numerous drugs. Examples of drugs whose absorption is decreased when taken with food include penicillin, tetracycline (TCN), erythromycin, levodopa, phenytoin, and digoxin. Drugs whose absorption increases when taken with food include spironolactone, griseofulvin, and itraconazole."

http://forum.roro44.com

ALL of this is nursing knowledge! When we give a med we should be aware of the possible interactions (food or drug) and how the drug can be administered (crushed, dissolved, whole). I had a surgeon who once ordered a pt to have MS Contin crushed and put through his NG! When I called him he told me that he is giving me the "order" to go ahead and crush it. I laughed and told him, "not a chance!" And suggested another form of Morphine what was appropriate to give through an NG. He actually said, "oh, ok... thanks!"

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"Our Doc's would not appreciate that question! "

It all depends on the doctor. Many are willing to put the intruction on the MAR (have seen it many times).

It is true that some foods may increase or decrease the absorption, but most of the meals that are served that I have seen are very well balanced so I would err on the side of decreased rate of absorption. I could be wrong.

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Specializes in Home Health- LTAC- Telemetry-.

sometimes the best option just doesnt exist, hopefully pharmacy can change the rout or the preparation of the medication but if not, I open it and mix it with apple sauce, I rather do that that have my 90+ year old patients not being able to swallow the pill or aspirate/asfixiate on me

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Specializes in LTC.
sometimes the best option just doesnt exist, hopefully pharmacy can change the rout or the preparation of the medication but if not, I open it and mix it with apple sauce, I rather do that that have my 90+ year old patients not being able to swallow the pill or aspirate/asfixiate on me

Be careful, if it says Do Not Open capsule.. you can't open it. They have to swallow it whole(mix whole in applesauce or pudding) or get it in another form.

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Thanks everyone for the input, I am glad I asked the question!!

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I didn't have time to read the whole thread and I hope someone has already referred you to this but if not here it is

http://www.ismp.org/Tools/DoNotCrush.pdf

This link is for the ISMP do not crush list. It is a great resource. I am new to ltc and I shared many of the same concerns you did. This list was really a big help!

I found one drug I was giving was a chemotherapeutic agent that you should wear gloves when administering and that another drug I was giving you could open the capsule as long as you didn't crush the contents and didn't put it in chocolate pudding.....Who knew? I was so happy to find this and I hope it is a blessing to you too.

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Specializes in LTC.
I didn't have time to read the whole thread and I hope someone has already referred you to this but if not here it is

http://www.ismp.org/Tools/DoNotCrush.pdf

This link is for the ISMP do not crush list. It is a great resource. I am new to ltc and I shared many of the same concerns you did. This list was really a big help!

I found one drug I was giving was a chemotherapeutic agent that you should wear gloves when administering and that another drug I was giving you could open the capsule as long as you didn't crush the contents and didn't put it in chocolate pudding.....Who knew? I was so happy to find this and I hope it is a blessing to you too.

Chocolate pudding has been my lifesaver when giving meds to confused residents.

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No do not open the capsule. The med is in it for a reason to protect from gastric juices or so that it is SR. You need to talk to the pharmacy and the doctor about getting another version of this tablet. It may require more frequent dosing as IR rather than SR.

VERY VERY True!! NOT all capsules can or should be opened!!!! There is a reason they are in capsules. AND if you talk to the pharmacy your facility deals with and they find out that the patient needs there meds crushed they are usually very good at supplementing with liquids or another alternate med or something. Then contact the Dr. Most Dr's are not made aware the patient needs there meds crushed and will agree with alternatives pharmacy suggests for such cases. Also, if order calls for PO, then thats what they mean....by mouth and as dispensed. IF for ANY other reason, you have to crush, place in applesauce, pudding, juice, Gtube, etc, YOU NEED AN ORDER!! You need an order from MD to administer medications crushed in pudding/applesauce in order to be doing so! If state was to come into our facility and we were seen crushing meds and placing them in pudding, not having an order, we would be dinked big time!! As PO stands for med to be given as dispensed, whole, capsule,liquid or otherwise.

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