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About the "do not crush" medications

Posted

Has 6 years experience.

I am working in a LTC, there are medications labeled " do not crush". I told my patient this medication is not supposed to be crushed or the capsule is not supposed to be opened, she said: I cannot swallow it whole! What should I do? if the State people is here watching me, what should I do?

Thanks!

sistrmoon

Specializes in Oncology. Has 13 years experience.

Some come in a suspension. Which meds?

ktwlpn, LPN, RN

Specializes in Med Surg, Homecare, Hospice.

Yes,you call the doc and ask to have it changed to a liquid or a perishable form

macawake, MSN

Has 12 years experience.

I am working in a LTC, there are medications labeled " do not crush". I told my patient this medication is not supposed to be crushed or the capsule is not supposed to be opened, she said: I cannot swallow it whole! What should I do? if the State people is here watching me, what should I do?

Thanks!

Whether or not the State people are watching or not isn't the important factor.

What's important is that the medication is administered in a safe manner and that it's absorbed correctly.

Pills can be labeled "do not crush" for many different reasons. They may be slow/extended release and crushing them will lead to the dose being absorbed too quickly (leading to a higher plasma concentration than planned) and likely not have sufficient duration. They can be enteric coated in order to delay release until the medication reaches the small intestines, instead of breaking down in the acidic stomach. The pill/capsule's content may be irritant and even cause ulcers in the esophagus if it's exposed to the content of the pill.

If you're uncertain you need to consult a drug guide, the prescribing physician or a pharmacist (whichever the policy of your place of work states). Many times the med is available in another formulation/route or sometimes the prescriber will have to change to a different medication if the patient is unable to swallow.

Mae_W, BSN, RN

Has 6 years experience.

I am a new grad, and I saw the past days that the "do not crush" medication were administered since it was ordered. And most of the patients' medications are crushed in apple sauce. I just feel so overwhelmed that 1 nurse for 48 patients and so many things that the seasoned nurses doing are not supposed to be done that way, and I cannot say anything. They would tell you things like they know what they are talking about, and they would stop me doing what's right, which they think it's unnecessary or that's not what they have been doing. I feel so unsafe practicing there, it's not safe for me, it's not safe for the patients! But it seems so hard for me to find a job, because I am a new grad with an ADN...Just ranting

macawake, MSN

Has 12 years experience.

I am a new grad, and I saw the past days that the "do not crush" medication were administered since it was ordered. And most of the patients' medications are crushed in apple sauce. I just feel so overwhelmed that 1 nurse for 48 patients and so many things that the seasoned nurses doing are not supposed to be done that way, and I cannot say anything. They would tell you things like they know what they are talking about, and they would stop me doing what's right, which they think it's unnecessary or that's not what they have been doing. I feel so unsafe practicing there, it's not safe for me, it's not safe for the patients! But it seems so hard for me to find a job, because I am a new grad with an ADN...Just ranting

I can easily see how you'd feel overwhelmed with 48 patients to care for. I would too, and I'm not a new grad.

Personally I wouldn't trust the word of another nurse about crushing a "do not crush pill" since I am personally responsible, both legally and ethically, for what I do as a nurse. I'd contact the provider and also read the drug guide since providers are human too, and can make mistakes. I know you know this, or you wouldn't be here asking for advice. I'm not lecturing you, just sharing my thought process.

Sometimes it might actually be acceptable to crush a "do not crush" medication and experienced nurses may know when this is, but sometimes it really isn't. The important part is finding out before doing it. After you gain some experience you'll be more familiar with the most common meds you administer and it gets a bit easier.

When I was a new grad I remember one case where the nurses during previous shifts had administered several doses of p.o. Clindamycin to a patient who had difficulties swallowing by breaking open the capsule and pouring the contents in applesauce. The patient's complaint of a sore/painful throat was noted in the chart. Small wonder I say... So yes, even experienced nurses sometimes make mistakes. It can be stress, fatigue, deficient knowledge or lack of diligence. Know Thy Drugs..

Good luck OP!

Edited by macawake
missing an o... to, too... :)

Mae_W, BSN, RN

Has 6 years experience.

I can easily see how you'd feel overwhelmed with 48 patients to care for. I would too, and I'm not a new grad.

Personally I wouldn't trust the word of another nurse about crushing a "do not crush pill" since I am personally responsible, both legally and ethically, for what I do as a nurse. I'd contact the provider and also read the drug guide since providers are human too, and can make mistakes. I know you know this, or you wouldn't be here asking for advice. I'm not lecturing you, just sharing my thought process.

Sometimes it might actually be acceptable to crush a "do not crush" medication and experienced nurses may know when this is, but sometimes it really isn't. The important part is finding out before doing it. After you gain some experience you'll be more familiar with the most common meds you administer and it gets a bit easier.

When I was a new grad I remember one case where the nurses during previous shifts had administered several doses of p.o. Clindamycin to a patient who had difficulties swallowing by breaking open the capsule and pouring the contents in applesauce. The patient's complaint of a sore/painful throat was noted in the chart. Small wonder I say... So yes, even experienced nurses sometimes make mistakes. It can be stress, fatigue, deficient knowledge or lack of diligence. Know Thy Drugs..

Good luck OP!

Thank you so much for all these good advise and information!

PA_RN87, MSN, RN, APRN

Specializes in Medical-Oncology, Nursing Education, Family Med.

Sort of a long these lines: At my facility we often give patients potassium, which comes in horse-pill sizes. The note in the emar order says "do not crush or chew," but goes on to say it can be dissolved in water. What?? What's the difference? If we can dissolve it in water (yuck), why not crush it and administer in applesauce?

Guest03/15/15, BSN, RN

Specializes in Emergency Room.

K-Lor can be and should be dissolved in water. Ive never heard of the K-tab/Kdur (pill) being dissolved in water. Ive heard of the capsule being opened and poured on applesauce, but thats not the ideal.

Whats your research?

Sort of a long these lines: At my facility we often give patients potassium, which comes in horse-pill sizes. The note in the emar order says "do not crush or chew," but goes on to say it can be dissolved in water. What?? What's the difference? If we can dissolve it in water (yuck), why not crush it and administer in applesauce?

I am working in a LTC, there are medications labeled " do not crush". I told my patient this medication is not supposed to be crushed or the capsule is not supposed to be opened, she said: I cannot swallow it whole! What should I do? if the State people is here watching me, what should I do?

Thanks!

Call the dr for something else sometime it will come in a form that can be crushed or can easily be changed

As long as you dont crush the "micro beads" ( my words not what you really call them) it's fine to dissolve once disolved looks like salt

CT Pixie, BSN, RN

Has 10 years experience.

Working in LTC for years, I've frequently come upon do not crush/chew meds and patient who can't swallow pills. (yet they can swallow food no problem.) Depending on the person I would put it either in applesause or in a pudding or custard and at times ice cream. Ofen pudding was better because it was thicker and the med stayed in the pudding instead of sliding out and being seperate from the applesause. I'd follow it by a nice big sip of a supplement drink/milk shake. But my tried and true was pudding. Worked like a charm for the majority of my patients.

If that didn't work, a call to the doctor for a liquid alternative was warrented.

NurseQT

Has 10+ years experience.

When I come across a med that cannot be crushed and it's ordered for a patient who takes all of the meds crushed I will first try it whole in pudding, if they still cannot swallow it I will call the MD and ask for an order for an equivalent med that can be crushed. Or if it can be d/c'd all together.

Some meds can be opened and given as long as they're not chewed ie: omeprazole. And the huge KCL pill can be dissolved in water, I add just a tiny bit so the pill dissolves down to a lump of sand consistency then mix it with pudding.

joanna73, BSN, RN

Specializes in geriatrics.

Check with your pharmacy. They will know if the medication comes in liquid form and/ or what a suitable alternative medication is for your resident if this is not the case.

LargeMarge

Has 10 years experience.

You have to document that the patient states they are unable to swallow the pill whole and it can't be crushed. Sometimes people can swallow the pill whole but coated in applesauce or pudding, but most likely they can't and to be on the safe side, you probably have to seek an alternative. I usually call the pharmacy first and see how else the pill can be supplied, liquid, suspension, or perhaps a capsule that can opened if appropriate. Then I call the doctor and tell them it needs to be ordered differently and give them the options I have already discovered are available from pharmacy. The doctor may not be aware of what the options are or what is specifically on the facilities formulary, so by getting the options for them you're hopefully saving them a step and getting your new order in place quicker.

classicdame, MSN, EdD

Specializes in Hospital Education Coordinator.

FYI: There is a list of Do not Crush meds on the ISMP website. 16 pages!

NutmeggeRN, BSN

Specializes in kids. Has 25 years experience.

K-Lor can be and should be dissolved in water. Ive never heard of the K-tab/Kdur (pill) being dissolved in water. Ive heard of the capsule being opened and poured on applesauce, but thats not the ideal.

Whats your research?

That was the order from the pharmacy in my facility....