Crushing K-Dur

[Zee_RN]

OVERHEARD:

NURSE A: "I just gave him his K-Dur." (Pt. is intubated with dobhoff in place with tube feedings.)

NURSE B: "We can't crush K-Dur."

NURSE A: "I know but that's what the doctor ordered, so that's what I gave. It's not my problem."

-----------------------

Personally, this frightens me. I do not, will not, crush a sustained release med just because the doctor wasn't smart enough to realize he was ordering it for a patient on tube feeds.

[MS._Jen_RN, ASN, RN]

not now said:

My question is: What do you do when you notify the MD the med is not crushable and he still wants it given?

I would try to get Pharmacy in on the discussion if you have a problem with this. Depending on the potential rxn to the crushing I might refuse to give it. (ex- crushing Oxycontin, Depekote, Ambien CR) I've seen this issue too much. The MD doen't stop to think about the right route for the patient so they order it PO by habit. Or they order it per tube and it's still a pill that can't be crushed. I know of times that it's been given anyway, usually by an RN who "didn't know" the pill couldn't be crushed. K-Dur is a pill made up of little balls of med. The balls are then stuck togeter. It crumbles easily but those balls can't be crushed. Sometimes we get a generic as capsule with the balls inside. The nurse who crushed this committed a med error (an knowingly did so). Her actions could have been detrimental to the patient depending on what she's crushing) This should be a reportable event. She, and probably some of the other staff need some education. ~Jen

[TiffyRN, BSN, PhD]

K-Dur will clog up a dobhoff solid as cement; guess how I know. Yes, I used to crush it before I was educated. It does not have the same release rate as other forms of oral potassium. This is one reason one must call an MD for an order change when there is an order for K-Dur through an enteral tube (or as more often is the case it is carried over from home meds).

Another one I didn't know about: Dilantin oral. The most common form of Dilantin pills are sustained release and are not to be automatically substituted with the liquid form, neither should they be opened (they are capsules). The MD will likely order the same # milligrams/day but might (should) order them spaced out through the day instead of at one dose a day. Besides those capsules send up this obnoxious tiny cloud of med that makes you cough. Yea, guess how I know that? There is a dilantin chewable tablet (50mg I think) that is obviously ok to crush since it's ok to chew.

Anyway, those are two meds that sometimes nurses don't know that must be reordered if a patient has an enteral tube.

[TazziRN, RN]

K-Dur will clog up a dobhoff solid as cement; guess how I know. Yes, I used to crush it before I was educated. It does not have the same release rate as other forms of oral potassium. This is one reason one must call an MD for an order change when there is an order for K-Dur through an enteral tube (or as more often is the case it is carried over from home meds).

Another one I didn't know about: Dilantin oral. The most common form of Dilantin pills are sustained release and are not to be automatically substituted with the liquid form, neither should they be opened (they are capsules). The MD will likely order the same # milligrams/day but might (should) order them spaced out through the day instead of at one dose a day. Besides those capsules send up this obnoxious tiny cloud of med that makes you cough. Yea, guess how I know that? There is a dilantin chewable tablet (50mg I think) that is obviously ok to crush since it's ok to chew.

Anyway, those are two meds that sometimes nurses don't know that must be reordered if a patient has an enteral tube.

Nothing like learning from experience!!

[wooh, BSN, RN]

If the doctor order the pt. to be shoved out the window, is she going to do that too??

Depends on the patient....

[Zee_RN, BSN, RN]

Depends on the patient....

Hoot!! LOL!

[HappyNurse2005, RN]

Well, it can be put in water and dissolved. I've done that several times and mixed teh crushed bit in applesauce (yeah, not doing it that way for the Jtube pt)

Our tube feeders usually get liquid kcl.

[bonesrn]

how do these idiots make it out of nursing school????

[SharonH, RN]

Well, it can be put in water and dissolved.

This is true. It cannot be crushed but it can be dissovled in water and given that way, perhaps that is how your co-worker gave it? Of course, it is easier to give the liquid form.

[UM Review RN, ASN, RN]

Happily, our Pharmacy is able to dose the equivalent without calling the doc. So it'd be changed to liquid for me. I'm messy enough as it is with those things.

[snowfreeze, BSN, RN]

Put K-dur in applesauce, it will slowly dissolve and is acceptable as it just dissolves the stuff that sticks the potassium crystals together. Liquid form for g-tubes, dissolve the while bullet in applesauce for those that have a problem with swallowing horse pills.

[all4schwa]

This is true. It cannot be crushed but it can be dissovled in water and given that way, perhaps that is how your co-worker gave it? Of course, it is easier to give the liquid form.

can all no crush meds be dissolved in water, or just this one?

how would you know?

[TiffyRN, BSN, PhD]

It is possible to dissolve K-Dur in water, just as it is possible to drink Lactated Ringers. It is not however intended to be dissolved or crushed. It is an extended release tablet (they try to clue us in with the "dur" part of the name of the drug). And yes it's generally safe to give a patient the same dose in an immediate release form of potassium chloride (K-lyte comes to mind), but if the MD orders K-Dur and the med needs to be given by enteral tube or patient cannot swallow the tablet then the med needs to be clarified.

Most of the time the MD's don't care if their patient gets K-Dur 20meq or liquid potassium choride 20meq. The best practise is to get them to change the order to the correct form designed for how the patient can take the med.

Extended or sustained release meds should not be crushed or dissolved.