crushing meds

[PsychNurseBoyMom, ADN, BSN, LPN, RN]

In my facility we are supposed to crush meds... Its the Sheriff's Department rule not my company's. I dont mind having to crush but 90 percent of my meds should not be crushed. I get looks from Deputies during my med pass and a few have said why am i not crushing pills. It is very frustrating. I don't want to get in trouble for not following a policy. Any body else run into this problem.

They make us crush so they can't "cheek their meds", we don't have any good drugs so i don't see the point.

[Esme12, ASN, BSN, RN]

HUmm tough question.....I have not worked correctional nursing however I do know that many inmates will cheek their meds to get sick enough to get a trip to the hospital or collect them for SI attempt ...we see them in the ED.

[morte, LPN, LVN]

you would need to get order changes to crushable meds, which likely will need more frequent dosing. good luck

[amoLucia]

Has this issue been brought up to your medical director or pharmacy consultant? This practice could be injurious to the inmates. I would guess that you would have to have these resources if you have meds involved.

Would never dream of playing lawyer, but someone could claim 'induced injury' or 'cruel & unusual'. Am just playing devil's advocate.

[Orca, ADN, ASN, RN]

We stopped crushing altogether. It is impossible to detect medication errors and it greatly alters the absorption rate and time of action of medications. It essentially gives an inmate a bolus of medications that should dissolve gradually in the digestive tract.

[Munch]

I hope they don't mean medications that are extended release! I mean it makes sense since some inmates may save their meds for a rainy day or to harm themselves, but it certainly may screw up the way the medication is absorbed thus making the dose not up to therapeutic par.

[VivaLasViejas, ASN, RN]

Any chance that you could get the medical director to change some of these to liquid versions? In any case, meds that shouldn't be crushed, shouldn't be crushed---period---policy or no policy. Sounds like you need to educate the non-nurses around you about what can happen if certain medications hit the bloodstream all at once.....in the end, what you give the inmates is YOUR responsibility, and YOU are the one who will suffer if something hits the fan because you followed their policy. Just sayin'.

[txredheadnurse, BSN, RN]

We always gave them in a moderately large quantity of water and the officer did a mouth check afterwards. This way the do not crush meds weren't altered significantly and it was more difficult to cheek the meds if they were already in the cup with water.

[classicdame, MSN, EdD]

go to the ISMP.gov website and print off the medications that should NOT be crushed (L O N G) list. Explain that to do otherwise would jeapordize your license and may be a liability for the county. Giving meds with a jelly also makes it harder to store in the cheek.

[BrandonLPN, LPN]

we dumped the pills into a cup of water and the inmates would swallow them while they "floated".

Is it really 90% of pills that you can't crush? That seems rather high. There's the extended release and enteric coated and a few oddballs like Fe. Instead of using EC aspirin, use chewable. I crush 10-15 meds a med pass for some of my LTC pts. there are very, very few issues with meds that can't be crushed. The doctor simply orders meds that are liquid or crushable. There really aren't that many pills that can't be crushed.

I would refuse to crush an EC med or a XL med. I would not crush those and go ahead and crush the rest. If a guard asks why there's a couple whole pills in the applesauce, just explain why. But I think saying you can't crush regular meds is taking it too far.

[wyogypsy, RN]

I work in a Level IV prison and we only crush a few med., Narcotics unless ER - and there are about 7 others but can't name them off the top of my head. If an IM cheeks pills then he doesn't think those meds are necessary for his health so any meds that were cheeked can be DC'd. I realize that they can always cheek meds quickly if they are good, but don't they open their mouth and lift their tongue and you look for any pills that are stored in their mouth?

[valzRN, ASN, RN]

If they are cheeking then they don't need it. That's the way I see it. Crush what you can and float the rest. That's what we do. All the psych meds are crushed. They don't get anything "good" anyway. It's none of the CO's business what medical does. If you have an issue with it then you should talk to your HSA or DON about it. In the end, it's your license. Protect that with everything you have!