Administering Capsules - page 3

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.... Read More

  1. Visit  miss81 profile page
    1
    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!
    Esme12 likes this.
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  3. Visit  Esme12 profile page
    0
    Quote from miss81
    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.
  4. Visit  GLORIAmunchkin72 profile page
    0
    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?
  5. Visit  miss81 profile page
    1
    Quote from GLORIAmunchkin72
    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!"
    wooh likes this.
  6. Visit  GLORIAmunchkin72 profile page
    0
    "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.
    Last edit by GLORIAmunchkin72 on Jun 8, '11
  7. Visit  caryrey02 profile page
    1
    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
    Forever Sunshine likes this.
  8. Visit  Forever Sunshine profile page
    0
    Quote from caryrey02
    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.
  9. Visit  nurs3ros3 profile page
    0
    Thanks everyone for the input, I am glad I asked the question!!
  10. Visit  SneakySnake profile page
    2
    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.
    wooh and Forever Sunshine like this.
  11. Visit  Forever Sunshine profile page
    0
    Quote from AuntieDi
    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.
  12. Visit  Nurse424 profile page
    0
    Quote from K+MgSO4
    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.
  13. Visit  WittySarcasm profile page
    0
    I usually use this list- http://www.ismp.org/tools/donotcrush.pdf

    Which is a common list that is in a lot of mars of LTC's. If you have the list in your mars just check and see if it is in the DO NOT list. If it is not and the resident needs pills crushed, then just open it and pour the applesauce.

    Any meds that have ER (Extended Release) or SR (Sustaned Release) you cannot open and those you may need to call the doctor or pharmacy and see if there is another way to give the meds.
  14. Visit  wooh profile page
    0
    Don't forget that sometimes the need to crush is taken into consideration with non-crushable meds. I've seen quite a few times a small dose ordered crushed and given more frequently because for certain patients, that was the best way to go. Very rare to have hard and fast rules in nursing and medicine.


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