Abstract
Objectives
To assess the modification of the form of medication and evaluate staff observance of good clinical practices
Design
One-day assessment of clinical practices.
Setting
17 geriatrics units in the 3 Teaching Hospitals of Paris-Sud (APHP), France.
Participants
Elderly in-patients with difficulties swallowing capsules and tablets.
Measurements
Assessment of target-patient prescriptions and direct observation of nurses’ medical rounds.
Results
155/526 in-patients (29.5%) were unable to swallow tablets or capsules: 98 (40.3%) in long-term care, 46 patients (23.8%) in the rehabilitation unit and 11 (12.2%) in the acute care unit (p = .005). In thirty-nine (27.3%) of the 143 prescriptions studied all tablets were safe to crush and all capsules were safe to open. In 104 cases, at least one medication could not be safely modified, including 26 cases (18.2%) in which none of the prescribed drugs were safe to crush or open. In 48.2% of the 110 medications that were crushed, crushing was forbidden, and presented a potential threat in 12.7% of cases or a reduced efficacy in 8.2% of cases. Crushing methods were rarely appropriate: no specific protective equipment was used (81.8%), crushing equipment was shared between patients without cleaning (95.1%), medications were spilled or lost (69.9%). The method of administration was appropriate (water, jellified water) in 25% of the cases, questionable (soup, coffee, compote, juice, cream) in 55% of the cases and unacceptable (laxative) in 21% of the cases.
Conclusion
Management of drug prescriptions in patients with swallowing difficulties is not optimal, and may even have iatrogenic effects. In this study, 12.7% of the modifications of the drug form could have been harmful. Doctors, pharmacists and nurses need to reevaluate their practices.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Caussin M, Mourier W, Philippe S, Capet C, Adam M, Reynero N, Jouini C, Colombier A-S, Kadri K, Landrin I, Gréboval E, Rémy E, Marc F, Touflet M, Wirotius F, Delabre N, Le Hiress C, Rorteau V, Vimard M, Dufour M, Tharasse C, Dieu B, Varin R, Doucet J. L’écrasement des médicaments en gériatrie: une pratique «artisanale» avec de fréquentes erreurs qui nécessitait des recommandations. Rev Med Interne 2012;33:546–51.
Paradiso LM, Roughead EE, Gilbert AL, Cosh D, Nation RL, Barnes L, Cheek J, Ballantyne A. Crushing or altering medications: what’s happening in residential agedcare facilities? Australas J Ageing 2002;21:123–7.
Stubbs J, Haw C, Dickens G. Dose form modification–a common but potentially hazardous practice. A literature review and study of medication administration to older psychiatric inpatients. Int Psychogeriatr 2008;20:616–27.
Kelly J, Wright D, Wood J. Medicine administration errors in patients with dysphagia in secondary care: a multi-centre observational study. J Adv Nurs 2011;67:2615–27.
Mercovich N, Kyle GJ, Naunton M. Safe to crush? A pilot study into solid dosage form modification in aged care. Australas J Ageing 2014;33:180–4.
Fodil M, Fillette A, Trivalle C. Considérations portant sur l’écrasement des médicaments en gériatrie. Neurol Psychiatr Geriatr 2013;13:35–40.
Barry-Perdereau V, Morea C, Friocourt P, Harnois C. Ecrasement des médicaments en gériatrie: mise au point et recommandations de bonnes pratiques. Rev Gériatrie 2015;40:463–470.
Prescrire Rédaction. Ecraser un comprimé ou ouvrir une gélule: beaucoup d’incertitudes, quelques dangers avérés. Rev Prescrire 2014;34:267–73.
Alexopoulos D, Barampoutis N, Gkizas V, Vogiatzi C, Tsigkas G, Koutsogiannis N, Davlouros P, Hahalis G, Nylander S, Parodi G, Xanthopoulou I. Crushed versus integral tablets of ticagrelor in ST-Segment elevation myocardial infarction patients: A randomized pharmacokinetic/pharmacodynamic study. Clin Pharmacokinet 2016;55:359–67.
Schiele JT, Quinzler R, Klimm H-D, Pruszydlo MG, Haefeli WE. Difficulties swallowing solid oral dosage forms in a general practice population: prevalence, causes, and relationship to dosage forms. Eur J Clin Pharmacol 2013;69:937–48.
OMEDIT Centre, 2014. Livret Therapeutique. Available at:http://www.omeditcentre. fr/fichiers/upload/Livret-geriatrique_OMeDIT-Centre.pdf Date accessed: 2016, June3.
Waitemata District health Board, 2016. Crushing guide for oral medication in residents with swallowing difficulties in residential aged care. Available at: http://www.saferx.co.nz/Crushing-table-RAC.pdf Date accessed: 2016, June3.
NHS, 2013. Options for patients unable to take solid oral dosage forms (tablets and capsules). Available at: http://www.medicinesmanagementstoke.nhs.uk/documents/Crushing_Tabs_FAQs_December_2011_FINAL.PDF Date accessed: 2016, June3.
ISMP, 2015. Oral dosage forms that should not be crushed. Available at: http://www. ismp.org/tools/donotcrush.pdf Date accessed: 2016, June3.
Vallat J, Barro-Belaygues N, Ramjaun Z, Lebrun N. Dysphagie de la personne âgée: quels sont les médicaments pilables? Soins Gerontol 2010;85:10–3.
Liste nationale des médicaments per os concernant l’écrasement des comprimés et l’ouverture des gélules, 2015. Available at: http://www.omedit-hautenormandie.fr/Files/sfpc_omedit_hn_tableau_mdicaments_crasables_juin_2015_protec.xls Date accessed: 2016, June6.
Marquis J, Schneider M-P, Payot V, Cordonier AC, Bugnon O, Hersberger KE, Arnet I. Swallowing difficulties with oral drugs among polypharmacy patients attending community pharmacies. Int J Clin Pharm 2013;35:1130–6.
American Geriatrics Society. Updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2015;63:2227–46.
O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing 2015;44:213–8.
Haw C, Stubbs J. Administration of medicines in food and drink: a study of older inpatients with severe mental illness. Int Psychogeriatr 2010;22:409–16.
Johannessen SI, Landmark CJ. Antiepileptic drug interactions -Principles and clinical implications. Curr Neuropharmacol 2010;8:254–67.
Ragueneau I, Poirier JM, Radembino N, Sao AB, Funck-Brentano C, Jaillon P, Pharmacokinetic and pharmacodynamic drug interactions between digoxin and macrogol 4000, a laxative polymer, in healthy volunteers. Br J Clin Pharmacol 1999;48:453–6.
Crepin S, Godet B, Gosse N, Nouaille Y, Merle L, Laroche M-L, 2013. Seizure after an interaction between laxatives for bowel preparation and an antiepileptic drug. VIII Congrès de Physiologie de Pharmacologie et de Thérapeutique. Available at: http://www.atout-org.com/p2t2013/abstract_display!fr!!!!624c3ea2-8abf-1030-b866-9251dd645b9d!bc970a90-d673-1030-b866-9251dd645b9d Date accessed: 2016, June3.
Bourdenet G, Giraud S, Artur M, Dutertre S, Dufour M, Lefèbvre-Caussin M, Proux A, Philippe S, Capet C, Fontaine-Adam M, Kadri K, Landrin I, Gréboval E, Touflet M, Nanfack J, Tharasse C, Varin R, Rémy E, Daouphars M, Doucet J. Impact of recommendations on crushing medications in geriatrics: from prescription to administration. Fundam Clin Pharmacol 2015;29:316–20.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fodil, M., Nghiem, D., Colas, M. et al. Assessment of clinical practices for crushing medication in geriatric units. J Nutr Health Aging 21, 904–908 (2017). https://doi.org/10.1007/s12603-017-0886-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12603-017-0886-3