About the "do not crush" medications

[Sam. W]

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!

[NurseQT]

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]

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]

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]

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

[NutmeggeRN, BSN]

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....

[dienw]

Here's the link to the do not crush list on the ISMP website. Notice that for certain medications it says that administering a crushed dose may be fatal. http://www.ismp.org/tools/donotcrush.pdf

[Vishwamitr]

Perishable form? What's that?

[PA_RN87, BSN, MSN, RN, APRN]

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?

Just like NutmeggeRN, that was the order from the pharmacy at my facility. It wasn't just haphazardly mentioned on a written order. That's how it shows up in the emar, every time, after pharmacy verifies the Dr order.

[BuckyBadgerRN, ASN, RN]

Reminds me of the cutest 95 year old gentleman who got "that" horsepill every morning. He "liked" it dissolved in his morning coffee "makes it taste like a ***** though" he'd say! He would take his pills in the morning before going out to the dining room and have us bring the K out to him for the dissolving in his coffee. He'd say about once a week "if you tripped and dropped that pill, I wouldn't tell anyone!"

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?

[Tenebrae, BSN, RN]

I work in LTC

We often get patients who struggle with taking pills. Our policy is that if a patient is unable to take the med its current form we must get an order from the patients GP for it in another form.

I have one patient who takes a capsule with micro beads in it unable to swallow the cap but can swallow the micro beads mixed into yogurt. Checked with our pharmacist who advised that as long as the microbeads arent crushed this is an ok method of administering some capsules.

Some things I have tried

- giving pills with yogurt or other such substance to ease

- if a large pill is able to be snapped in half, doing so making a smaller thing to swallow.