Question about crushing meds

[BJLynn]

The floor I am usually assigned too has three residents who have "crush" orders who also happen to take birth control pills. Now me, I don't crush the BC pills because they are so tiny and I want to be assured the resident is getting all of the hormones. And none of the residents have trouble swallowing them. Some of the other nurses crush them. I don't like this because there always seems to be some powder left in the cup after mixing the meds with applesauce or pudding. Our residents have enough difficulties without messing with their hormones too.

What do you do (or what would you do), and what is your rational for it?

[leslie :-D]

i think the crush orders should be honored.

of course, you can always ask the pts why they have their meds crushed.

but i can think of far more many meds that i find necessary to be given in their entirety, than bc pills.

and i can't figure out why there should be residual powder when mixing with applesauce/pudding.

leslie

[ginger58, ASN, RN]

I think your concern about the BCp is valid. A lot of them are very small. Sometimes I think docs get reports from nursing or other care staff that the pt. can't swallow or has trouble taking meds and knee jerk is to crush.

Maybe I'd ask the doc when I saw him or leave him a note in the chart if it's OK to give the BCP without crushing.

I did a lot of looking to see if there's a reason not to crush a BCP and I couldn't find anything. I thought maybe it would rush its absorption but it doesn't seem to matter.

[Retired R.N.]

i think the crush orders should be honored.

of course, you can always ask the pts why they have their meds crushed.

but i can think of far more many meds that i find necessary to be given in their entirety, than bc pills.

and i can't figure out why there should be residual powder when mixing with applesauce/pudding.

leslie

Extended release medications should never be crushed or split. I would certainly question any order that called for that. Everywhere that I have ever worked has used crushing only as a last resort when a patient simply cannot swallow a whole tablet.

An intact tablet can often be swallowed if it is given inside a spoonful of pudding or flavored yogurt, and followed by several more spoonfuls of the pudding or yogurt to help ensure that the tablet actually has gone down the throat. Applesauce doesn't work as well because it doesn't have the smooth creamy texture.

As for the residual powder? What method do you use for crushing? I would suggest that a charge of static electricity is built up during the crushing and causes the particles to cling to the container rather than mix easily into the food.

[zacarias, ASN, RN]

One way of doing it is instead is by mixing the crushed med and applesauce IN the med cup, put some apple sauce (or pudding) in a spoon and poor the crushed med, which is powder now, on top. It's kinda weird but I've done it and it avoids the extra-powder-in-the-cup problem.