Crushing Oral Medications...New Regulation - page 4

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)... Read More

  1. by   CapeCodMermaid
    It's not your management forcing this on you. It's CMS. The state surveyors don't have any input...they do what they're told from their bosses. This is one of the stupidest regs I've seen and I've been in the business for more than 25 years.
  2. by   Glycerine82
    Quote from bluegeegoo2
    I am thinking of a lady that I take care of that has dementia with behaviors. These behaviors consist of beating the hell out of anyone who comes near, scratching (some staff have scars) biting (no teeth, thank God) spitting directly in your face and cussing you like a dog. You are lucky to get one bite of crushed meds into her. You've hit the lottery if you can manage two. I get her meds into her by making her a delicious "shake" that she drinks right up. Meds administered. Moving along.

    She takes seroquel, risperdal, and depakote among other things. I would have to decide which meds to give first. The seroquel? Risperdal? No chance to get them all in her.

    Besides the obvious need to keep behaviors at a minimum, imagine the horrific withdrawal she would suffer if she were suddenly not getting these meds. She would likely end up in a short-stay psych facility to get stabilized only to come back and withdrawal again and again.

    I guess "they" didn't consider scenarios like that when conjuring up this rule. Smh.
    My point exactly. I understand what they are getting at, in theory, but this is only going to harm the patients, not help them. It seems like they are hoping that docs will D/C meds that aren't "necessary" in order to make folks more likely to comply, but what I've gathered based on the time's i've tried to do just that, is the random supplements, statins, protonix, etc. are not D/C'd for some type of CYA.

    They go on to say "does the resident want their meds in food"? - Um, No. They don't want them at all!

    "are the meds being hidden in food (I'm assuming applesauce counts as "food} because the resident is refusing the meds - Um, yeah! They are.... so we should just let them all refuse, right? CHF can just rear it's ugly head, bowel obstructions will happen left and right and folks will start to stroke out when they don't take their HTN meds. Hey - they have that right!

    It's so maddening. You would let a two year old refuse their seizure meds, these folks are no different.

    I would NEVER sneak meds into an alert and oriented patient, but folks with dementia really can't be allowed to refuse if there is any possible way of getting them to take their meds. I'm not going to hold them down and pinch their noses until they open up, but I sure will slip them some chocolate pudding laced with lisinopril if that's what it takes.
  3. by   CapeCodMermaid
    It is against every regulation to hide medications in food--applesauce, pudding. You're forcing someone to take meds when they clearly don't want them. Even someone with dementia has the right to refuse anything. Do you force them into the shower? It will have to be the FAMILIES putting pressure on CMS to change this. Caregivers have no clout.
  4. by   Orion81
    Quote from ltcnurse4u
    Someone at work had stated it was because when a resident spits out a medication that is crushed, you do not what medication it is because the meds have been crushed together. This is ridiculous and will cause more harm than good to the residents. I have yet to see the risks vs benefits .
    I was thinking this was the reason. However, once already crushed and mixed individually, we no longer know which med they spit out just the same. Absurd. And we're not suppossed to write it with a sharpie on the med cups.
    So after giving 1 patient 6 med cups of crushed meds mixed, and they refuse or spit out, or don't finish even ONE, we are suppossed to know without a single doubt WHICH med they missed HOW exactly. Ridiculous and nauseating to think about.
  5. by   Orion81
    Quote from CapeCodMermaid
    It is against every regulation to hide medications in food--applesauce, pudding. You're forcing someone to take meds when they clearly don't want them. Even someone with dementia has the right to refuse anything. Do you force them into the shower? It will have to be the FAMILIES putting pressure on CMS to change this. Caregivers have no clout.
    Meanwhile, in the real world....
  6. by   jenean
    I work in a long term care facility and have several residents with swallowing issues. Please reconsider this mandate. These people will either not get all their meds or they will aspirate. I don't see how separating them will be beneficial. Thank you.
  7. by   adm8185
    I do not think this new regulation is a good idea because nurses already do not have enough time to administer medications in a timely manner. I do not see any benefit for the patient with this new way of administering medications, it only makes it more difficult for the patients that already have a hard time taking medications. We all know that with some patients you only have one opportunity to give these meds and with this new way many medications will NOT be administered. The next time rules and regulations are presented for change or approval put yourself in the shoes of these geriatric patients!!!!!!!
  8. by   LadysSolo
    They are trying to accomplish the nurses being sure what meds the resident is refusing, which I get. But they are going to accomplish the residents refusing all the meds, or if they take their meds, refusing their meals (which are more nutritious) because they are full of applesauce or pudding. Then you will have a weight loss, which will require more supplements, which will further reduce the amount of meals taken, etc, etc. I think any regulations should come from someone who has actually had to work in LTC.
  9. by   packisnumber1
    We just got this memo from Pharmacy today. I can't believe this is even going to go into effect!! I work in a memory care unit and take care of 23 dementia residents. I also have another hallway with general population. I might as well pass medications all day and forget doing anything else! Some of my patients take 10+ meds in the mornings!! If I use more than the bare minimum of pudding, there's no getting those meds in! Sigh, this world is messed up!! I need a different profession!!!
  10. by   Daisy Joyce
    ...but...I DO take my mess and supplements while eating my breakfast.
    In your face surveyor!
  11. by   kbrn2002
    Update on this. There's been such an incredible amount of pushback that the policy has been amended. Our pharmacist came in this week and requested a list of all residents that take meds crushed or via enteral tube. All we need is an MD order to mix crushed meds for administering. Our pharmacy is getting the orders and processing them for us
    Last edit by kbrn2002 on Nov 16 : Reason: Stupid phone auto correct

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