Sooo many crushed meds...

  1. 0 I am a new Grad, just started in a LTC facility. I have no complaints about the place, the DON is wonderful, very supportive, I got a great orientation...ect.
    One thing that I am not comfortable with is that ALOT of the residents get ALL their meds crushed. I know they have swallowing problems but even drugs that shouldn't be crushed are. I just read an article about how this can be dangerous for some meds, and I am nervous that something may happen down the road and I will be at fault for crushing meds when they shouldn't be crushed... even though everyone does it.

    How should I handle this?

    Bea
  2. Visit  beatrice1 profile page

    About beatrice1

    Joined Feb '09; Posts: 167; Likes: 37.

    16 Comments so far...

  3. Visit  Mom2boysRN profile page
    6
    Contact your pharmacy and see if the meds that shouldn't be crushed come in liquid form.
  4. Visit  beatrice1 profile page
    0
    I thought about that, but I guess I'm really wondering why veteran nurses are still doing this? I'm the new girl that has to come in and "shake things up"?
    Last edit by beatrice1 on Nov 17, '11 : Reason: spelling
  5. Visit  classicdame profile page
    2
    the veterans are doing it out of ignorance or "because everyone else does". Ask the pharmacy to supply you with a list of meds that should not be crushed. You may be surprised. Then let your DON see the list and perhaps post it. Metformin is one that should not be crushed.
    LockportRN and michelle126 like this.
  6. Visit  SweetseRN profile page
    1
    Noooo, don't do it just because everyone else does. You can really hurt someone if you crush the wrong med (potassium comes to mind, eep!) There is always some other alternative. Call the pharmacy or doc for sure.
    LockportRN likes this.
  7. Visit  loriangel14 profile page
    5
    I see this at work too but the fact is that many of the meds I am giving do not come in liquid form or the patient cannot swallow liquids.Usually our choice is give them crushed or they don't get them at all.
    joanna73, hoopschick, yooperPN, and 2 others like this.
  8. Visit  46oldnewrn profile page
    7
    You can always add the meds to water that say "do not crush" but I must say In my 4 years of nursing not a SINGLE DARN PERSON has died because their med's were crushed. Just Sayin!!
    joanna73, egglady, Forever Sunshine, and 4 others like this.
  9. Visit  birdie22 profile page
    2
    Its usually the sustained release/extended release type of meds that shouldnt be crushed. Most other meds are ok.
    LockportRN and sweetnurse63 like this.
  10. Visit  cindyloowho profile page
    3
    You can't really get many "do not crush" meds in liquid form, as it is the enteric coating that creates the extended release. The physicians should be asked to switch the patient to another med that is comparable in function but with different dosing (if possible).
  11. Visit  NotFlo profile page
    2
    Quote from cindyloowho
    You can't really get many "do not crush" meds in liquid form, as it is the enteric coating that creates the extended release. The physicians should be asked to switch the patient to another med that is comparable in function but with different dosing (if possible).
    Yes and crushing enteric-coated meds or other meds that shouldn't be crushed was something the state was specifically checking for during our last survey...and of course they observed the nurse doing just that.

    What really sucks is when you ask the doc for a form that can be crushed now you're going from a daily med usually to a three or four times daily med which just increases the work load and stress for everyone involved, including the resident who doesn't want to be taking any pills in the first place.
    hoopschick and loriangel14 like this.
  12. Visit  beast master RN profile page
    0
    Quote from 46oldnewrn
    You can always add the meds to water that say "do not crush" but I must say In my 4 years of nursing not a SINGLE DARN PERSON has died because their med's were crushed. Just Sayin!!
    i love that , and its so true , i too work in a ltc facility , and i work in a wander risk hall with all dementia pts . all but one person you have to crush there meds , some of the res will refuse there meds everyday every time just because they have no idea what your doing, two specific residents will only take there meds in penut butter and jelly sandwiches , as a nurse sometime you gota do what you gota do, within reason of coarse, is it better i give this person their ativan , bp med , diabetes med ect ect or just circle it as not giving cause they refused??
  13. Visit  cindyloowho profile page
    6
    "You can always add the meds to water that say "do not crush" but I must say In my 4 years of nursing not a SINGLE DARN PERSON has died because their med's were crushed. Just Sayin!!"

    Sure, people aren't really gonna die,(at least we hope not!) but they are not getting their needed medications in a timeframe that is appropriate. It's like getting a big bolus when you need the med to work slower and for longer.

    Here' let me crush your oxycontin...you'll feel good for a bit, but then have fun being in pain for the rest of the night when this wears off in 2 hours. Geesh
    LockportRN, LTCangel, morte, and 3 others like this.
  14. Visit  maelstrom143 profile page
    0
    And this is why I would never return to LTC. Too many practices that make me question protocol/practice. Being in the hospital environment is so much easier as far as getting a hold of pharmacy, doctor, etc.
    Definitely, if you have a pharmacy to contact, do so and see what they suggest. Then you can call the PCP and tell him your concern and what pharmacy suggests. Some docs will go with the pharmacy suggestions. Others will tell you to follow the orders (I have had irate doctors tell me to mind my own business and not tell them how to take care of their patients in the past). Just do what you need to do and CHART, CHART, CHART!


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