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.

[carolmaccas66, BSN, RN]

Oh Lord, who has the TIME to mix every single med in separate sauce? They can still refuse to take a med half way thru, if you have mixed them and people refuse, there isn't a darn thing you can do about it.

Sweetie, if you give meds the way your instructor tells you, you will never get off your shift. We RNs were having a discussion re this the other day. One RN said you shouldn't crush many medications, but unless the pharmacist writes on the med chart (their responsibility) they get crushed. Then if we don't crush a med, the patient won't take it if it's too big due to dysphagia issues, etc.

This is why I hate nursing homes. I've seen elderly people held down (when I was a student) and their mouths held open to get them to take meds. It's disgraceful. There HAS to be a better way of delivering meds, for example, patches or creams put on the skin after people have washed. The old applesauce and crushing them just doesn't work, & nursing home administrators don't give a hoot.

I had to give meds like this for nearly all of 65 patients one shift. Can u imagine if I had done each one separately? I would never have got home - & I was still late giving handover. Never again.

Get pharmacist input - they can tell u which ones get crushed or not. I mean reasonably, most people who don't need meds crushed, you give meds to them, they put the whole lot in one hand and swallow them whole, plus if u do give meds separately, they all get mixed up in HCL anyway in the stomach, so why do we bother?

I so hate doing this in nursing homes - I will never go back to this system. As nurses I think we have to advocate for a better way of giving meds.

[CapeCodMermaid, RN]

You must have been a student nurse in the 1960's. This kind of treatment hasn't been allowed in a long long time.

[headinsandRN]

why exactly was your teacher upset?

[danh3190]

I crush the meds separately. And I prioritize them, e.g. cardiac and BP meds before vitamins, and give them in that order. If a couple of the meds are very small so they can be given in one bite, I mix them. Sometimes the patient stops taking meds part way through and at least the most important meds get in. On my floor we usually don't have to crush anyone's meds and if so usually only one patient.

I like the idea of using pudding. I may try that next time.

[nurse2033, MSN, RN]

I crush everything and put it in a small amount of applesauce, say a mouthfull or two. Mixing meds in 8oz of applesauce is overkill, unless you know the patient will eat it.

[xtxrn, ASN, RN]

You must have been a student nurse in the 1960's. This kind of treatment hasn't been allowed in a long long time.

Curious, what is this in reference to?

I've seen both schools of thought in the past 10 years :)

[wooh, BSN, RN]

I would NEVER mix them in a whole container of applesauce. I would mix them all together though. The amount of applesauce it would take to mix them separately is a LOT more than the amount to mix them all at once.

I understand the logic of "If they don't take them all..." but in reality, they're more likely to take them all if you have them mixed up in the minimum necessary, so mixing them separately just makes it more likely they won't take them all.

[xtxrn, ASN, RN]

This probably won't help a soul, but what the hey- I'm feeling wacky tonight

I had a lady (first door of med pass) who took about 2/3 of the PDR- whole, but EACH pill in a spoon of applesauce....AND, with perfectly functioning arms (not even enough wrong for a rehab aide to screen) had me feed them to her.

And, to add to the joy of it all, she would look at the little rock on the sauced spoon, eyeball it for a few seconds, then look up at me (in a w/c) and tell me the name, like she were guessing the $1M question on a game show.

Can't tell y'all how much I looked forward to those mornings

Actually, after the meds (and repeated with the noon rounds), she was fairly pleasant- but it had to go well with that first med pass or I could count on requests for whatever PRNs she had ordered...at hourly intervals.

[That Guy, BSN, RN, EMT-B]

Sorry but if i have to crush them, its because they typically cant swallow very well and I will use as little applesauce/bites as possible so as to get them all down.

[RNperdiem, RN]

While you are in school, you will do it the way your instructor tells you to do it.

Here is what I did when I worked med-surg.

I would take two medicine cups. I would divide meds into essentials and others. The essentials (cardiac meds, psych meds etc.) would be mixed with applesauce and given first. Then the other meds(mostly vitamins) would go next. If the patient balked or refused after the first bite, then I would know which meds were taken.

[Esme12, ASN, BSN, RN]

Personally, I would mix each med in a separate 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 separately 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 separate cups of water, rather than mixing them all together.

Actually this is the right answer.....Well done! That and I wouldn't argue with your instructor. Technically speaking the theory is also that to crush the meds together can, in some cases, change how they interact chemically changing the meds and it's effectiveness and potency. The same goes for meds through the G-tube/NGT. But in the real world it doesn't happen that way, should it? yes but does it? no....

[SuesquatchRN, BSN, RN]

While you are in school, you will do it the way your instructor tells you to do it.

Here is what I did when I worked med-surg.

I would take two medicine cups. I would divide meds into essentials and others. The essentials (cardiac meds, psych meds etc.) would be mixed with applesauce and given first. Then the other meds(mostly vitamins) would go next. If the patient balked or refused after the first bite, then I would know which meds were taken.

I do the same thing for problem med-takes. Essentials first. And ice cream is better accepted than the unsweetened applesauce we had. Nasty, let alone with bitter meds crushed in.