crushing medications

[file03]

crushing medications for pegs/ngts and for mixing in food for patients...

I'm 2 months into being a new nurse. at my facility almost every patient has a peg tube. I've been doing the "proper" way, crushing each med separately, and having mini cups and not mixing any together and flushing in between.

I see nurses just crush and mix all of them. my patient load is getting higher and I really can't do it the "proper" way anymore.

so before I start crushing and mixing everything together in a cup... what medications should I make sure NOT to mix with each other? or does it really matter? I've heard the pharmacy at my place should tell you about medication interactions, but I'm paranoid and don't want to rely 100% on them.

thank you. :redpinkhe

[GingerSue]

drugdigest is one source and it has a section where

you can check drug interactions:

http://www.drugdigest.org/DD/Home

[morte, LPN, LVN]

they are all going to the same place......any interaction issues should have been covered when ea was ordered, by spacing them out.....however to protect your self, you should get an order from physician that they may be given together/at the same time

[nrsang97, BSN, RN]

I was taught to mix them together and flush afterward. They are going to the same place so even if they took them all whole what is the difference except that they are now crushed? Some meds cannot be crushed like K-dur or other extended release meds.

[Murse901, MSN, RN]

The rationale behind crushing/administering each med separately with a flush inbetween is to prevent clogging the peg with pill residue. I have never known there to be a question of compatibility when crushing meds for G-tube, because as others have said, they are all going to the same place and any compatibility issues should be dealt with beforehand (flushing between those meds isn't going to negate an incompatibility).

There isn't really any other reason to avoid mixing the meds. Consider that some pt's have orders to crush meds in applesauce. Do you crush each med individually and give them a little swallow of applesauce with each crushed pill? No, you just mix them all together in the applesauce and go to town.

If you can avoid clogging the G-tube while administering meds in this manner, go for it if you feel you have to. Just don't get caught by JHACO/CMS/your nursing supervisor because they will have a fit.

[leslie :-D]

it's true, what donald said.

individual administration allegedly decreases risk of clogging/obstruction.

just crush well and flush even better.

leslie

[RN1982]

Some nurse I used to work with tried to convince me that you don't mix the meds because of incompatibility issues but aren't they mixing in the stomach? It didn't make any sense.

[crunchymomx3]

I always thought it was odd that people would site drug interactions when crushing meds and putting them in a G tube but no one worries about it when a patient swallows a handful of whole pills that have been ordered for administration at the same time.

[WSU_Ally_RN, BSN, RN]

Where I work, we have been told it is a mandate from Joint Commission to no longer crush all meds and give at once... we can get written up if seen doing this. I don't know if it's just a scare tactic, or something real that Joint has come up with to make our jobs just a little more difficult...

[madwife2002, BSN, RN]

The first time you clog the PEG tube by mixing all meds together and giving will be the last time you do mix all meds together and give trust me. The time it takes to give individually with flushes inbetween gets less the more you do it. But the time it takes to unblock a tube can take a very long time and is a pain in the backside.

I have had to give a lot of meds via tubes in my lifetime, and honestly it takes longer to work out which med can go with which med than to do it one at a time.

[madwife2002, BSN, RN]

I always thought it was odd that people would site drug interactions when crushing meds and putting them in a G tube but no one worries about it when a patient swallows a handful of whole pills that have been ordered for administration at the same time.

There is no problem for a patient in giving all the meds crushed together, the problem occurs when the mixed meds solidify when mixed together in water and pushed in the peg tube.

This tube is the pts life line and normally the patient is weak so another trip to the OR because a nurse is too lazy to do individual pushes is not only negligant but not cost effective

[loriangel14, RN]

Where I work we crush and then dissolve in water so you get no clogs.We still flush after of course.