Our pharmacy sent out newsletter on Monday that states:
As of November 28, 2017, phase 2 of the new federal regulations will take effect. Part of the changes relates to crushing oral (PO) medications. The new regulation states:
"Crushed medications should NOT be combined and given all at once either orally (e.g in pudding or similar food) or via feeding tube."
We have known medications given via feeding tube cannot be cocktailed unless there is an order from the MD with a clinical indication to do so. However, the separation of crushed ORAL meds is new and there is no wording in the regulations allowing for any exceptions.
Additionally, if a surveyor observes medications being crushed and combined, then the number of errors would be equal to the number of medications crushed. For example, if five medications are crushed and combined, then this would count as 5 med errors. If the med error rate is greater than 5%, then the facility is sited under F759.
We do have concerns regarding separating crushed medications. It could result in resident medication refusal, fluid overload, and decreased meal intake for certain residents. This is in addition to increase nursing medication administration time. The updated regulations focus on person centered care. Hopefully this applies to med crushing as well. Can crushed medications given orally be combined if the resident prefers and the risks vs benefits are explained to the responsible party? If there is a contradiction to separate the medications and the prescriber documents the rational with risks vs benefits, will this suffice?
I work at a small facility and I have about 15 residents who requires crush meds. 5 of them have more than 10 different meds and take their meds like little baby birds.
How will the new regs affect your med pass??
What are the risks vs benefits of giving crushed meds separately?
