Administering Capsules

[nurs3ros3]

Nurses:

I need your help! I am a brand new nurse and just started a job at a nursing home. I have a question regarding the administration of a capsule medication to those who cannot swallow pills.

As those of you who work with the elderly, or children know, patients cannot always swallow their pills easily and must have the medications crushed in applesauce. However, some of these medications come in a capsule which cannot be crushed. As a new nurse I am following the advice of the other nurses on the floor who have suggested that I crush what I can and then mix whatever I can't in with applesauce. However, I am concerned that this may not be the best option. What other method is there? Can the capsule be opened and the contents emptied into the applesauce or is trying to get the patient to swallow the capsule really the best option?

Any suggestions would be greatly appreciated. I am a new nurse and I want to do the right thing!

Thanks in advance!

[loriangel14, RN]

I usually open the capsule and mix the contents in with the applesauce. Not always the recommended method but sometimes it's either that or they won't the med at all.

[K+MgSO4, BSN]

No do not open the capsule. The med is in it for a reason to protect from gastric juices or so that it is SR. You need to talk to the pharmacy and the doctor about getting another version of this tablet. It may require more frequent dosing as IR rather than SR.

[honeykrown, MSN, NP]

I would say just open the capsule and pour it on a spoonful of apple sauce so the patient at least gets the whole capsule. if it is mixed with the whole apple sauce, you run the risk of the patient not taking the whole sauce.

[Hospice Nurse LPN, BSN, RN]

When in doubt, I call the pharmacy r/t what can and cannot be opened or crushed.

[debRN0417]

Call the pharmacy. There are some capsules that can be opened and the contents sprinkled, but some cannot. You also should have a reference at your facility that tells you which meds can be crushed or opened...

[Forever Sunshine, ASN, RN]

I open the capsule and mix the beads inside with applesauce or pudding. There are some that you can't open the capsule.. those I mix whole with applesauce/pudding.

[Whispera, MSN, RN]

Capsules are on medications to slow down absorption of the medication. They're intended to let the medication get into the small intestine before it's fully dissolved. The same is true for coated pills. If you remove the contents and give the contents without the capsule or coating, you risk giving the patient too much medication all at once.

If the patient can't swallow the whole capsule (or coated pill), call the doctor for a medication change. Sometimes doctors don't think this through fully when prescribing something. You're their eyes and ears.

[wooh, BSN, RN]

Capsules are on medications to slow down absorption of the medication.

In some cases. Sometimes it's just to package x amount of medication in an "easy to swallow" pill.

Best bet is check with pharmacy to determine which is which.

[KellyRPNinOntario]

Not all capsules need to wait until the intestine. You just need to research each med. I open many capsules that the pharmacy said was fine. In my experience anything that cant be opened will state "do not crush". The meds that must be absorbed by the small intestine usually say something like EC (enteric coated), SR or SR (slow release), ER (extended release). Hope this helps!

[DSkelton711]

Very good question from the OP! Never be afraid to ask questions, we all benefit from learning! I def would go with asking the pharmacist on what to do. Good Luck in your career!

[sameyjaney]

My advice is to talk to pharmacy and ask them if you can open the capsule. I went through this very same thing when I first started. Nurses were like, "I was always taught to open these ones." Obviously, I still questioned it because being new you question EVERYTHING. I called Pharmacy and sure enough that specific pill I was referring to you could open. However, there are many which you can't. When I question a new pill I will call again. :)