Crushing Oral Medications...New Regulation

[ltcnurse4u]

Our pharmacy sent out newsletter on Monday that states:

As of November 28, 2017, phase 2 of the new federal regulations will take effect. Part of the changes relates to crushing oral (PO) medications. The new regulation states:

"Crushed medications should NOT be combined and given all at once either orally (e.g in pudding or similar food) or via feeding tube."

We have known medications given via feeding tube cannot be cocktailed unless there is an order from the MD with a clinical indication to do so. However, the separation of crushed ORAL meds is new and there is no wording in the regulations allowing for any exceptions.

Additionally, if a surveyor observes medications being crushed and combined, then the number of errors would be equal to the number of medications crushed. For example, if five medications are crushed and combined, then this would count as 5 med errors. If the med error rate is greater than 5%, then the facility is sited under F759.

We do have concerns regarding separating crushed medications. It could result in resident medication refusal, fluid overload, and decreased meal intake for certain residents. This is in addition to increase nursing medication administration time. The updated regulations focus on person centered care. Hopefully this applies to med crushing as well. Can crushed medications given orally be combined if the resident prefers and the risks vs benefits are explained to the responsible party? If there is a contradiction to separate the medications and the prescriber documents the rational with risks vs benefits, will this suffice?

I work at a small facility and I have about 15 residents who requires crush meds. 5 of them have more than 10 different meds and take their meds like little baby birds.

How will the new regs affect your med pass??

What are the risks vs benefits of giving crushed meds separately?

[Tenebrae, BSN, RN]

It is against every regulation to hide medications in food--applesauce, pudding. You're forcing someone to take meds when they clearly don't want them. Even someone with dementia has the right to refuse anything. Do you force them into the shower? It will have to be the FAMILIES putting pressure on CMS to change this. Caregivers have no clout.

If a patient has advanced dementia they have an active EPOA/welfare guardian in place for personal care and welfare, and as long as we have the EPOAs permission to treat, you can bet your bottom dollar that we treat if clinically appropriate

I recall a wee chap who had an sigmoid volvulus, which would be relieved by use of a recatal tube. This chap had advanced dementia and it didnt matter how much we explained it he would always refuse the tube. Now, we could have chosen to be directed by that, and watch his stomach become more and more tympanic, face the risk the bowel becomes ischaemic and then he dies from what is an easily preventable reason. Fortunately his EPOA had given us permission to perform the procedure when needed

Good idea in principle...

[Tenebrae, BSN, RN]

I know this is an old thread, however that is absolutely mad. I'm sure it was written by some mid level bureaucrat with no idea of what things are like on the floor.

Admittedly crushing the medication will change how its absorbed. But do we go for the patient getting some of the medication effects, or none because they arent able to take the whole tablet and there is no oral liquid option avaliable

When I worked in specialist dementia hospital care, hiding the medications in food was the only way we could get the patient to take them. Now, we could choose not to give them however we then face potential withdrawl symptoms from abruptly stopping medication, or the complications related to stopping what ever medication they needed to try and keep them halfway healthy