Med crushing

Kimburly · Dec 22, 2002

Whoa, you must work with mentally competent adult patients exclusively! It is pretty near impossible to get consent from a dementia patient, especially in the end stages, but butts would be hung out if that stopped them from getting their cardiac meds and caused death!

I worked 5 years in LTC and the majority of our residents couldn't have consented to each pill. And can't swallow whole pills, so crush and mix is the only way to get them in. Most liquid forms of meds require a pretty large amount of liquid for a comparitive dose and believe me none of them taste good!

Now I work peds and we still crush meds, and parents are consenting to treatment. We mix in cherry syrup or chocolate syrup. But we aren't giving as many meds to each patient as in geriatrics. Many pharmacies have a variety of syrups to mix meds in, if you can get your facility to invest it may work for some patients who don't need a lot of meds at once.

nursedawn67, LPN · Dec 22, 2002

The doc reviews the chart and determines if the drugs they are on can be crushed and then orders it, many times if cannot be crushed it is either given in a liquid form (if available) or that one med is given whole or the doc just decides to d/c it or change to something crushable. Meds are not crushed to decieve a patient they are crushed d/t swallowing difficulties or occasionally a patient just finds it easier to take their meds in applesauce and some dementia/alzheimers patients will not take their meds and the meds need to be crushed in order to ensure they get them.

cindyln · Dec 22, 2002

When my daughter was younger I put her theophylline sprinkles in applesauce.To this day she hates applesauce,will not touch it anymore and she is 20.

Vsummer1 · Dec 22, 2002

Originally posted by donmurray
I still have concerns around this subject. In the UK, all meds are individually licenced for use, and that includes the form of presentation. If you crush a tablet, or open a capsule before administering it, you are then technically administering an unlicenced medication.
On the practical side, many meds are timed-release, or packaged to survive passage through the stomach before they begin to act. This function may be impaired, if not negated, by crushing. Crush a sustained-release tab, and the patient gets the whole dose at once! Crush an enteric-coated tab, and the constituents may be destroyed by gastric acids so that the patient gets no dose at all. Crushing meds with a hormonal content, such as Tamoxifen, exposes the staff member to the active ingredients of the drug. If a patient truly has a swallowing problem, then there are a variety of presentations available as alternatives to the tablet form. Most meds are available as liquids, for example.
The other aspect, which I touched on before, is that of consent. Fine if the patient is A&O, and aware that they are receiving their meds in whatever foodstuff is used, but if they are not, then you may be denying them their rights. Starting from the premise that everyone has the right to accept or refuse a treatment, covertly giving a medicine may be a method used to bypass that right for the sake of the nurses' convenience in getting the job done on time.

I can understand your concerns on this, but in first semester they teach us about enteric coated / time release etc. and how / what can and cannot be crushed. Crushed meds take longer to administer so this isn't for the nurses convenience. Believe me, having to take the mortar and pestle, grind it up, put it into food then stand there and feed the medication takes much longer than just giving a pill and watching them swallow! It is used for those pts. with a swallowing disorder, for tube feeds, or for dementia patients that won't take the meds any other way.

The nurse who administers the medications needs to help the patient get their meds. Crushing is just one way to do that, and of course is only used on medications which can be safely administered that way.

Forcing a medication is a violation of patients rights, but if the patient is unable to give consent themselves, then consents are obtained from family (or whoever is custodian). So this isn't about bypassing the patient's rights at all -- it is about safely and effectively administering medications to those who need it.

AlZee · Dec 29, 2002

We use applesauce and sometimes pudding for the residents that don't like applesauce. I've tried almost anything that's in complience with meds and diet. As you know some of the Residents in a LTC can be very fussy!!!!!

longtimecoming · Jan 9, 2003

I'm a CNA in a LTCF (and student nurse) and my favorite RN puts his meds in vanilla pudding mixed with orange marmalade. The "chunks" from the marmalade help disguise the chunks of meds. I've seen some normally taste-sensitive pts take his mix with barely a grimace.

maureeno · Jan 9, 2003

this thread demonstrates the vital importance of individualizing nursing care plans.