Giving meds crushed in applesauce

[anastasia158]

As we all know, when someone takes oral meds, they take them all at once with water. Today I was administering meds with my clinical instructor. I was to give crushed meds in applesauce. I had them all crushed and was thinking that I could place all the crushed meds in applesauce, mix it and feed all of the applesauce to the patient.

However, my instructor had me separately mix each medicine in its own plastic cup of applesauce. This ended up being time consuming and I am trying to figure out why that would have been necessary. My instrictor ended up getting upset with me over how putzy it ended up being.

[roma4204, BSN, RN]

In real life nursing you combine meds unless there's a reason not to

[sbostonRN]

That is the "book way" to do it. If for some reason you were not able to administer every pill to the patient, you'd want to know what you gave. Not think "hmm I gave half of this cup that includes aspirin, atenolol and calcium"... In the real world I crush everything together and give it all at once. However if we ever had an inspection I don't think this practice would be allowed. For now, just do it the way your instructor says to.

[Double-Helix, BSN, RN]

Personally, I would mix each med in a seperate cup, with about one spoonful of applesauce per med.

Why?

1. An entire cup of applesauce can be a lot for some people. If you mix all the meds in the whole cup and the patient suddenly decides halfway through that they don't want anymore, then you don't know which meds the patient has taken.

2. If the patient throws up in the middle of administering meds, you don't know which meds the patient has gotten.

3. If you have all the meds mixed in one cup and you drop the applesauce on the floor, you don't know what meds have been given.

Basically, mixing each med seperately ensures that you know which meds the patient has taken and how much they have taken. It eliminates any doubt about what meds have been given if something interrupts the med administration. It's the same reason why we crush and administer GT meds in seperate cups of water, rather than mixing them all together.

[WolfpackRed]

some would tell you to give each med separately in applesauce or via NGT/OGT/PEG because if that med were spit out lost ow whatever than you as the nurse would have an idea which med it was. if you mixed them all together and portion was "lost" how would you know which and how much?

but as the previous poster said, it is easier and less time consuming to give all at once.

[LoveMyBugs, BSN, CNA, RN]

Personally sounds like a waste of time, but if I had to guess,

I think her reasoning would be if the resident refused to take one, then you would know what one they were refusing.

Sometimes the confused elderly may only take 1-2 bites of the applesauce/med then refuse the rest of it. so then you would want to know what they did or did not take.

But you would have to ask your instructor what her rationale was for doing it that way.

I know when giving meds through the PEG tube you crush mix with water and put each med in seperatly with a 5ml flush between, so you know what meds the patient is getting incase something where to happen.

Now real world nurse I would crush up all the meds and try to make my applesauce mixture only 1-2 bites anyway so if they refuse the last little bit then you got the most you could in them.

[jocelynlpn, LPN]

That is way too time consuming. I crush and mix meds in thickened juice with a honey consistancy. Then use a liquid med cup so you're not giving too much. Sometimes, if I know my patient can tolerate it, I just put all the pills in thickened juice without crushing them. It's easier to swallow that way.

[loriangel14, RN]

That's the difference between real world and nursing school.Many of my patients get their pills in applesauce not because they won't take them whole, but rather they can't.The only time I put them in a separate cup if there is a chance of refusal and it's something important like sedation medication.

[sbostonRN]

I work in LTC and we have many patients who take their meds in applesauce. The cup size is only a 30 mL med cup, so it's only a couple of bites anyways...not too much for most people in my experience!

[kelll]

unfortunately I believe the best way to give the meds is one at a time...that is if you have the time. I personally put a few in applesauce at a time, usually giving the ones that MUST be taken NOW like pain meds etc and giving vitamins last or later if need be. Many of the meds that are scheduled together are done so kind of generically and can usually be given later if need be.

[CapeCodMermaid, RN]

We crush them all together and give in a med cup full of apple sauce, pudding, or ice cream. Most anyone get tolerate two little bites. Again, you need to assess the resident and follow your facility's policies.

[nurseprnRN, BSN, RN]

i see this done a lot when the patient can't swallow well...but the problem is that in that case the patient is much better off getting something to swallow that holds together better than applesauce, in terms of avoiding aspiration. don't believe me? call your local slp (speech-language pathology) therapist and have her explain it to you. have a swallow study done.

thickened liquids or puddings will actually hold together better in a swallow than applesauce. applesauce is one of those nursing old wives' tales that lives forever.

perhaps a liquid med--put it into thickened liquid or pudding-- would be better. the pharmacy can at least see that you get one that doesn't taste as vile as crushed meds. eaten a crushed aspirin lately? yecchh.

otherwise, yep, if you want to know what your patient has actually consumed, you'll have to give the meds separately.