Communication between nursing/pharmacy Crushing Meds

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Specializes in Float.

I would like feedback from other nurses on a topic I am working on for our hospital.

We are finding a breakdown when a patient is receiving crushed meds by mouth ie in applesauce. This is only rarely an issue with feeding tubes as the med is normally ordered "PT" and pharmacy catches that it can't be crushed. However with PO crushed the pharmacy has no way of knowing we are crushing the meds.

How do you alert pharmacy so that they can catch this? How do you educate nursing staff that it is inappropriate to crush certain meds:

for instance CR or ER; or potassium; or enteric coated; or that some meds are in capsules for a reason and shouldn't just be opened and dumped right in to the applesauce/pudding/etc.

Thanks for any feedback!

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Specializes in home health, dialysis, others.

You should have an MD order to crush meds which should of course go to the pharmacy. Do not take it upon yourself to start crushing meds without notifying the doc and the pharmacist first.

If the pt truly cannot swallow pills that cannot be crushed, alternative forms of the meds must be utilized.

Sometimes I am totally amazed that issues I had 35 years ago ARE STILL ISSUES!!!! Have we not progressed at all?

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Specializes in Float.

We do have MD orders to crush meds, this is done after speech sees the patient. But the breakdown is 1) pharmacy isn't integrating this into our eMar

2) nurses know to crush meds, but don't seem to recognize it's not appropriate to crush any and all meds.

Do any hospitals have some type of seperate "route" for crushed meds on their med orders to designate? Or some type of alert that stays attached to the patient on the MAR?

Mamamerlee - I concur on why aren't nurses educated not to crush CR/ER/EC etc? I see nurses that have been nurses a LONG time crushing potassium etc; Everytime I get a patient with orders to crush meds I find at least one or two meds that are being crushed inappropriately and must call and get it changed. Hence I'm working with our practice counsel to try and get a process improvement to resolve this hospital wide.

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On our computer printed out MARs, certain meds always have certain instructions/comments that print with them. Some of those are comments include, take on empty stomach, take only with meals, Do not crush, etc. So, no matter how the med is ordered, those instructions appear. The prudent nurse reads his/her MAR and follows it. I know there are many who crush them all anyway, though.

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Specializes in floor to ICU.

Our computerized MARs say things too (like take on empty stomach, do not crush, etc...) but sometimes they dont make sense. I had a pt on Protonix. They were the granules and the directions on the MAR said "do not crush, do not mix with water. Mix with applesauce". :confused: This was going thru a PEG and the MAR even stated the route was "per Gtube".

Hmmm, exactly how am I supposed to mix the stuff with applesauce and cram it down a G tube?

I dont routinely get an order first. I just call pharmacy and tell them that the patient has a NGT/PEG and see which meds we can change per protocol. If there is not a substitute, pharmacy gives the recommendation for another med and either pharmacy or nursing calls the MD to get the ok.

Oral K+ tabs will dissolve in water and shouldnt be crushed.

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Our computerized MARs say things too (like take on empty stomach, do not crush, etc...) but sometimes they dont make sense. I had a pt on Protonix. They were the granules and the directions on the MAR said "do not crush, do not mix with water. Mix with applesauce". :confused: This was going thru a PEG and the MAR even stated the route was "per Gtube".

Hmmm, exactly how am I supposed to mix the stuff with applesauce and cram it down a G tube?

I dont routinely get an order first. I just call pharmacy and tell them that the patient has a NGT/PEG and see which meds we can change per protocol. If there is not a substitute, pharmacy gives the recommendation for another med and either pharmacy or nursing calls the MD to get the ok.

Oral K+ tabs will dissolve in water and shouldnt be crushed.

you mix them with apple juice....

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Specializes in ICU, ER, EP,.

We use a computer for our med administration, it provides warnings prior to administration. In addition we have a web site where if we are to administer the med and are unsure of it's uses, we simply click on it and it will say if it can be crushed.

For those with paper MAR's... geeze, you're stuck looking up each med? I don't have experience in this.. only that if the patient progressed from NG or PEG feeds to crushed PO, I'd always call pharmacy with those I would administer for the night for their review. Not everyone even has pharmacy... so I don't know if I"ve helped or not....:confused: It may boil down to the book for those not computerized.

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Our phamarmacy sent us a list of medications that cannot be crushed and the reasons and we keep this in the front of MAR.

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Specializes in floor to ICU.
you mix them with apple juice....

lol! I swear the MAR said applesauce! Now, I will have to go back and look again.:D

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lol! I swear the MAR said applesauce! Now, I will have to go back and look again.:D

lolol, it may well have, i was just clarifing that for a tube it would be the juice.....but po it WOULD be sauce...

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Specializes in Hospital Education Coordinator.

our nurses have access to Micromedex, which is like the PDR online. Easy to access and they have a list of do not crush drugs. Seems Pharmacy could create this list and post it in the area of medication administration

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