Crushing pills on long term care facilities

[newgrad1988]

Question... I'm new at being a nurse and always question myself. I work on a long term care facility and tonight before I gave a patient trazodone the aid told me they have been crushing his pills due to them finding whole pills under his bed. So I crushed the trazodone without checking before if it was a crushable pill or not. Now thinking about it I believe it's an extended release and you are not suppose to crush those. I guess my question is, can you crush trazadone or is it really one that you should not and will cause serious side effects?

[Cuddleswithpuddles]

Trazodone comes in immediate and extended release forms so you would have to check which form you have/will be giving.

Do you have a drug guide you can consult while giving meds? If not, I highly suggest you get one to help put your mind at ease and to make fulfilling your responsibilities in giving meds much easier. Online forums are great but are no replacement for peer-reviewed references like the Davis Drug Guide and Micromedix.

[Silverdragon102, BSN]

Would be also a good time to talk to the MD and pharmacist and if they require crushing get the changed to the type, if not already, that can be crushed

[classicdame, MSN, EdD]

There is a 16 page list of drugs that should not be crushed. The list is on the Institute of Safe Medicine Practices website. You could print it out and keep it handy at work, or see if it can be loaded to the facility computer.

[pinkiepieRN]

I work in LTC and the only Trazodone I've ever seen is indeed crushable. Most of the meds that aren't crushable will say XR/SR/LA, etc. but I agree with printing out a list of those which are "no-nos". Off the top of my head, things I don't crush include Depakote SR, Protonix, Nifedipine XR, Effexor XR, and anything that comes in a capsule. Now I want to go look at all the MARs in the building and make a more comprehensive list. Oh the things I like to do on my down-time.

Here's the link to the official list: http://www.ismp.org/tools/donotcrush.pdf Some of them are "do not crush" because of their action (SR, DR, XR) and others are "do not crush" due to taste.

[Umberlee]

Maybe it's a state rule, but we are not supposed to crush meds without a doctor's order. Typically, though, they will not look at individual medications but rather will just say "okay to crush all meds" or something like that, so we still have to watch to be sure they aren't getting an enteric-coated or extended-release medication crushed or whatnot. In that case we'd go to the physician and request an alternative preparation like syrup, sprinkles, etc.

[pinkiepieRN]

Maybe it's a state rule, but we are not supposed to crush meds without a doctor's order. Typically, though, they will not look at individual medications but rather will just say "okay to crush all meds" or something like that, so we still have to watch to be sure they aren't getting an enteric-coated or extended-release medication crushed or whatnot. In that case we'd go to the physician and request an alternative preparation like syrup, sprinkles, etc.

There's a check-box on our admission orders for "may crush meds unless contraindicated or otherwise stated" that normally gets checked by nurses on default. We can also check a box for "send in liquid or water soluble form if available". Most of this is a given for residents with g-tubes but it also goes for anyone with dysphagia or a modified diet.