RN - Crushing medications

[DDdove, LPN]

I was trained in my facility for three days and have been working now for a couple months. While reading through the threads I find that now I see I am supposed to be crushing meds separately. So do I put each med in a different cup with pudding and carry all those to the resident? Some have 6 meds! That times 30 residents? You cant stack cups

with pudding

[pinkiepieRN]

The only time that I would give each crushed medication separately would be for someone with a g-tube. With a g-tube, it's essential to give the med, then flush, then give another med, then flush. I find that residents who need their meds crushed are often reluctant or resistant to taking them; I can't imagine how that would be with 6 meds or more for each resident. Indeed, you can't stack cups with pudding for a variety of reasons. So don't.

How do other nurses at your facility give their crushed meds?

[Jessie71385]

I agree with the above - pinkiepie. The only time you have to do them separately is with residents with PEG tubes. Otherwise, mix up with applesauce/pudding/jelly and go!

[CapeCodMermaid, RN]

Check your facility policy. We dump all the meds in one cup to crush them and administer them that way. We will be going toward the same thing for gtube meds since we get as many liquid ones as we can. It all goes to the same place and NO ONE has time to separately crush that many meds.

[vampiregirl, BSN, RN]

If your facility's policy is to crush separately (I have heard of this before), find out if you ask for an order to crush the meds together. Or, find out how to get your facility's policy updated - I'm sure there would be some appropriate EBP materials to validate your request. One of the things regulatory agencies look at is if the staff are following the policies of their facility - it doesn't always matter if the policy is practical or even the most up to date, just if the staff are following it.

[IsmeAmanda, LPN]

Our facility crushes all separately then combine them in 1 cup.

UNLESS its tube meds, then flush separately. Ask your policy director.

[TheCommuter, BSN, RN]

I only crush medications separately if a state surveyor is watching me. Otherwise, I crush and mix all pills together. After all, the medication is going to mix when it enters the resident's stomach anyway.

[NutmeggeRN, BSN]

If they are likely to stop taking the crushed meds halfway through, I will split them and give the most critical on the first mouthful and go from there. That way I know they they got their Digoxin or Lasix, which are more critical that their Calcium supplement.

A little time consuming but for those patients who quit mid dosing, I at least can say I know what they did or did not get.

[NurseQT]

Can't say I've ever heard of crushing PO meds separately... You wouldn't give them separately if they were whole, unless that's how the resident takes them. Obviously you can't crush ER meds but the there's no logic behind crushing each med separately. When we have residents who have a peg or NG we'll call the pharmacy and ask which meds can be crushed and administered together, saves a lot of time when there's 10+ meds to give at one time.

[IVRUS, BSN, RN]

VIA ISMP (Institute for safe medication practices) states:

Improper administration technique

Most nurses rely primarily on their own experience and that of coworkers for information regarding the preparation and administration of enteral medications; few rely on pharmacists, nutritionists, or printed guidelines, which has resulted in a variety of improper techniques and an overall lack of consistency. The most common improper administration techniques include mixing multiple drugs together to give at once and failing to flush the tube before giving the first drug and between subsequent drugs.

Appropriate administration techniques must be used to prevent compatibility issues (between medications and the feeding formula) and tube occlusions. Information about drug compatibility with feeding formulas is limited and may not be applicable to different formulations of the same drug or drugs within the same class. For example, liquid morphine in a 2 mg/mL concentration decreases the pH of the feeding formula and results in a precipitate, but a 20 mg/mL concentration does not. Compatibility issues between the formula and drug can result in tube occlusions.

Compatibility between multiple drugs being administered together can also be a problem, particularly if two or more drugs are crushed and mixed together before administration. Mixing two or more drugs together, whether solid or liquid forms, creates a brand new, unknown entity with an unpredictable mechanism of release and bioavailability. Proper flushing of the tube before, between, and after each drug can help avoid problems.

[BrandonLPN, LPN]

The only time that I would give each crushed medication separately would be for someone with a g-tube. With a g-tube, it's essential to give the med, then flush, then give another med, then flush. I find that residents who need their meds crushed are often reluctant or resistant to taking them; I can't imagine how that would be with 6 meds or more for each resident. Indeed, you can't stack cups with pudding for a variety of reasons. So don't.

How do other nurses at your facility give their crushed meds?

Really? Its "essential" to crush each med separately when giving through a g-tube? And flush between each med? Whatever arguable benefit there is from doing so is negated by the time it would take, keeping the nurse from being able to perform tasks that are truly essential.

[_iamkel]

If you crush all meds together and give them all at once and your patient has a life threatening reaction, how will you know which medication did it? Better yet, how will you know which antidote to give if there are multiple options given the medication you administered. I guess that's why there are policies that say to do it separately. Time consuming, yes. The struggle is real!