Published Jul 4, 2007
Mrs. M.
47 Posts
When you administer crushed pills via GT, do you dilute each one in water separately, or do you combine them? Our facility has always allowed us to combine them (assuming they are crushable and compatable), but we can't find any resource that says it's okay to do that. They all say to administer them one at a time. What is your practice?
ashleyjean3
74 Posts
i miss them all together....except iron i always give it alone....and most vitamins
nicuRN2007
240 Posts
I don't really see why it would matter whether or not you mix them...they all mix in the stomach anyway. :wink2:
CapeCodMermaid, RN
6,092 Posts
The State surveyors tell us you must give one med at a time with a 5cc water flush in between each one. I'm with all y'all. If you swallow them you usually take a bunch all at once. Probably just another example of a regulation NOT based on any factual info
*grin* yes, that's what all of the nurses are saying. We are finding that the g-tubes are flowing a lot more smoothly now though. I just wish I could find some resource that addresses this. Every book an article that we've found says to administer them one at a time.
meownsmile, BSN, RN
2,532 Posts
I can totally see the rational behind the practice of giving one at a time and flushing after with 5 cc. Although time wise its not always feasible to do it that way. Only problem is if you arent real careful you can clog up the end of the tube and if it isnt flushed out completely can set up like concrete. Then you have a whole other set of problems.
TheCommuter, BSN, RN
102 Articles; 27,612 Posts
Since I am lazy, I combine the meds and administer them because, as a previous poster mentioned, they are going to mix in the stomach anyhow.
catslave
71 Posts
Our facility requires us to administer meds separately with a 5cc flush in between.
PoppaD
46 Posts
I fail to see the rationale behind the practice of giving each med seperately f/b a flush (except in the case of incompatible meds of course). If anything, you are more likely to clog the tube after flushing it with only 5ml water. And...let's consider the pt who takes 15 meds. We check our residual, return it, and flush, then we give a 5ml flush in between each med...so we end up giving a total volume of 75 ml of flush plus whatever volume that was required to actually dissolve the meds into solution (easily 10ml or more). So, our final volume introduced to the resident might very well be on the order of 150 - 200ml. Now we have a pt who is in danger of aspirating! :angryfire
And let's not forget that the Joint Commission is requiring us to label any type of solution that has been poured from its original container. I feel sure that the Joint Commission would apply this logic to us carrying meds mixed with water (or whatever) down the hall because "you MIGHT just have to stop AND set you meds down AND someone MIGHT come across your meds AND they MIGHT not know what they are AND take them mistakenly because they weren't labeled..."
You have to use reasonable common sense. Of course if a patient is getting 15 plus meds, anyone is going to expidite the matter and not give each one with 5ml of water to flush following. Time wise it isnt going to be practical. However, not giving all 15 meds crushed in one concoction and giving an adequate flush between instillations is proper technique.
Also, considerations for the type of tube being used is going to make a difference on how much liquid can be used. Prudent nursing judegment and policy is the key.
Giving 15 meds at one time isn't a good idea regardless of whether you mix them or not. If I swallowed 15 meds I suspect it would upset my stomach. I also don't want to have to worry about compatibility on all of those meds. I'd talk to pharmacy and get them spread out over the day.
We don't add the water before taking the meds into the room - we take a cup of warm water with us and add it to the med cup at the bedside. The packaging that the pill came in is under each cup. It doesn't really take extra time, it's just a matter of changing habits.
marjoriemac, LPN
231 Posts
Yeah, I have to admit I oftenmix them but protocol does say to do them all seperate with 5-10ml flush in between. I have experienced meds clogging the tube before as well though and that can be a real pain.