How do I peel pill packets without meds flying everywhere!

[hs4zu]

Hi all! I have a silly question that keeps tripping me up at clinicals. Anyhow -- the way our meds are distributed in the hospital are in these sticky individual foil packets, and I feel that when I peel the foil back, it can cause the pills to pop out and fly off and on to the floor. Has anyone else had this problem?

I try to keep my thumb over the pill as I peel back, but at my last shift when I tried to do that, I had a controlled substance just tumble on out onto the floor -- and not only did I feel like an idiot in front of my preceptor but it was the end of the world with the pharmacy. Do you have any suggestions, such as opening inside a plastic bag? Or keeping a scissor with you? I appreciate any tips or tricks with med pack opening!

[ResearchRN25, BSN, RN]

I always hold mine over the med cup as I peel back, have you tried that?

[Ruby Vee, BSN]

Scissors!

I've had the same issues for the past 40 years. I just use scissors.

[bgxyrnf, MSN, RN]

I do both of the above.

I'm also super careful as I'm peeling back and get near the pill.

Sometimes, once I've got the pill partially exposed I will flip it over so the flat side is facing away from me and the blister side is facing me. Then I hold the end or edge of the pill between my thumb and flattened forefinger in my right hand while grasping the plastic blister with my left and pushing the pill through with my right thumb. This works better with oblong pills and hard pills... doesn't work at all with things like ODTs or capsules.

I've had patients that were nasty enough that I've stood there in the med room facing a moral dilemma of whether to pick the pill up off the floor and give it anyway or do the ethical thing. Thus far, honor and ethics have won out every time but I'll admit that it's perversely tempting sometimes.

[akulahawkRN, ADN, RN, EMT-P]

Well, the *ultimate remedy* is to take a hammer and bludgeon the poor wretched soul that invented the infernal things in the first place!

I'm kidding... I wouldn't actually do that... but I truly do detest those infernal blister packs. At my hospital with very FEW exceptions, our PO/SL meds come prepacked in those blister packs. Unfortunately there seems to be little standardization about what kind of blister pack that will be used so we have at least 3 or 5 different (some slightly different) blister pack packaging. Some are easier to open than others and I usually just get a 4 oz dixie cup and open the meds over the much larger dixie cup and do it slowly. I've had only ONE med drop to the floor since I started doing this. Oh, and for some types of packaging, it's just MUCH easier to use clean scissors and go slow peeling apart the packaging.

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

Have you ever tried just pushing it through the pack into a med cup? If it's not a 'do not crush' med, simply push it through if you feel that you can't peel it open according to instructions. It may split the pill in half, but that's ok.

[SHGR, MSN, RN, CNS]

Yup, scissors! Should be part of your standard clinical orificenal.

[RookieRoo]

why on earth would it be the end of the world with pharmacy? At my hospital, we just had to waste it in MAK (sometimes with a witness, depending on what it was) and then get a new one out...

anyways, I do sympathize with you on the blister packs. Infernal, annoying things! I try to open mine over the cup but I have had my fair share of pills go flying.

[Kuriin, BSN, RN]

Most of the meds in the packs can be pushed through. You have to be careful though with meds like Synthroid as they are easily broken when you do this. I think that's the only medication (Maybe Renvela?) that does this for me. I am a chronic nail biter, so I have to tell myself to not bite my nails so I can pull apart them. ;-x

[la_chica_suerte85, BSN, RN]

Ugh, I have this same problem! When I was precepting at a rehab place and every patient was on docusate, ugh, jeez those packets were more secure and harder to get through then getting over the fence at the White House to say, 'Hi' to the President!!! I always had my bandage scissors (which, I really only use to cut paper and foil packets...hah! ) and I just started saying, "Eff it." and cut the packet so I either could tear it just a little more to get that stupid gel tab....just...a...little....easier. Eventually, I got used to strong arming those bad boys and getting them out without feeling like I was going to launch it across the room. So, yeah, like with every other skill, they just take practice. It seems so ridiculous because we are able to get our own OTC PO meds at home without this happening, right? Something about that bulletproof packaging in the hospital, it's just crazy. But, you'll get used to it. For now, just use your scissors to cut your various sacred meds open like narcs and benzos. Eventually, you won't need to.

[la_chica_suerte85, BSN, RN]

Well, the *ultimate remedy* is to take a hammer and bludgeon the poor wretched soul that invented the infernal things in the first place!

Yes................. This is the only solution. Seriously, who invented them? Not a nurse, obvs.

[Kuriin, BSN, RN]

Colace can be pushed through the packet.