Hostname: page-component-669899f699-2mbcq Total loading time: 0 Render date: 2025-04-27T01:34:14.596Z Has data issue: false hasContentIssue false
  • English
  • Français

Dose form modification – a common but potentially hazardous practice. A literature review and study of medication administration to older psychiatric inpatients

Published online by Cambridge University Press:  22 August 2007

Jean Stubbs ,
Camilla Haw  and
Geoff Dickens
Jean Stubbs*
Affiliation:
St Andrew's Healthcare, Northampton, U.K.
Camilla Haw
Affiliation:
St Andrew's Healthcare, Northampton, U.K.
Geoff Dickens
Affiliation:
St Andrew's Healthcare, Northampton, U.K.
*
Correspondence should be addressed to: Mrs. Jean Stubbs, Head Pharmacist, St. Andrew's Healthcare, Billing Road, Northampton NN1 5DG, U.K. Phone: +44 (0)1604 616214; Fax: +44 (0)1604 616089. Email: [email protected].
Get access

Abstract

Background: Many older patients have difficulty in swallowing their tablets and capsules. Dose form modification, by crushing tablets or opening capsules, is often used by nurses to administer such medication.

Methods: Electronic searches of five literature databases on tablet crushing and capsule opening were carried out. A review of medication incident reports involving tablet crushing from the U.K. National Reporting and Learning System (NRLS) was also undertaken. An observational study of medication administration on two long-stay wards for older mentally ill inpatients was carried out in a large psychiatric hospital.

Results: Only 17 incidents involving tablet crushing were reported to NRLS in 13 months. In the observational study, the administration of 1257 oral doses of medication at 36 medication rounds was observed. Tablets were crushed or capsules opened for 25.5% (266/1045) of solid oral doses. For 44.0% (117/266) of these doses the tablet crushing had not been authorized by the prescriber. For 4.5% (12/266) of doses crushing was specifically contra-indicated by the manufacturer. In 57.5% (153/266) of doses, tablet crushing was avoidable by the correct use of more suitable preparations. Crushing caused contamination, spillage and hygiene problems.

Conclusions: Although tablet crushing and capsule opening are common practices, they are rarely reported as causing patient harm. Tablet crushing can often be avoided by the use of more suitable preparations. Crushing tablets and opening capsules are contra-indicated for some preparations. Older patients' medication may benefit from review by a pharmacist in order to optimize safe medication administration. Where tablet crushing is unavoidable, attention to cleanliness, contamination and spillage are necessary.

Keywords

tablet crushingcapsule openingelderly mentally ill
Type
Research Article
Information
International Psychogeriatrics , Volume 20 , Issue 3 , June 2008 , pp. 616 - 627
Copyright
Copyright © International Psychogeriatric Association 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Barnes, L., Cheek, J., Nation, R.L., Gilbert, A., Paradiso, L. and Ballantyne, A. (2006). Making sure the residents get their tablets: medication administration in care homes for older people. Journal of Advanced Nursing, 56, 190–199.CrossRefGoogle ScholarPubMed
BBC News (2006). I will always blame myself. (Available online at http://news.bbc.co.uk/1/hi/health/6085292.stm.)Google Scholar
Bloem, B. R., Lagaay, A. M., van Beek, W., Haan, J., Roos, R. A. C. and Wintzen, A. R. (1990). Prevalence of dysphagia in community residents aged over. 87 BMJ, 300, 721–722.CrossRefGoogle Scholar
Cleary, J. D., Evans, P. C., Hikal, A. H. and Chapman, S. W. (1999). Administration of crushed extended-release pentoxifylline tablets: bioavailability and adverse effects. American Journal of Health System Pharmacy, 56, 1529–1534.CrossRefGoogle ScholarPubMed
Cohen, M. R. (1982). Medication errors: always clean the mortar and pestle after crushing tablets. Nursing, 12, 25.CrossRefGoogle Scholar
Cornish, P. (2005). Avoid the crush: hazards of medication administration in patients with dysphagia or a feeding tube. Canadian Medical Association Journal, 172, 871–872.CrossRefGoogle ScholarPubMed
Freeman, H. (2003). Crushing blow. Daily Mirror, 17 April.Google Scholar
Griffith, R. (2003). Tablet crushing and the law. Pharmaceutical Journal, 271, 90–91.Google Scholar
Ho, C. Y. W., Dean, B. S. and Barber, N. D. (1997). When do medication administration errors happen to hospital inpatients? International Journal of Pharmacy Practice, 5, 91–96.CrossRefGoogle Scholar
Jordan, S., Griffiths, H. and Griffith, R. (2003). Administration of medicines, part 2: pharmacology. Nursing Standard, 18 (3), 45–54.CrossRefGoogle ScholarPubMed
Kirkevold, Ø. and Engedal, K. (2005). Concealment of drugs in food and beverages in nursing homes: cross-sectional study. BMJ, 330, 20–22.CrossRefGoogle ScholarPubMed
Lesar, T. (2002). Prescribing errors involving medication dosage forms. Journal of General Internal Medicine, 17, 579–587.CrossRefGoogle ScholarPubMed
Macdonald, A. (2001). The prevalence and recognition of dementia in non-specialist nursing homes for the elderly in South Thames. Research Findings Register: summary number 605. (Available online at: http://www.refer.nhs.uk/ViewRecord.asp?ID=605.)Google Scholar
Marriott, J. L. and Nation, R. L. (2002). Splitting tablets. Australian Prescriber, 25, 133–135.CrossRefGoogle Scholar
Morris, H. (2005). Dysphagia in a general practice population. Nursing Older People, 17 (8), 20–23.CrossRefGoogle Scholar
NMC (2006). A to Z Advice Sheet on Medicines Management. London: Nursing & Midwifery Council.Google Scholar
Paradiso, L. M. et al. (2002). Crushing or altering medications: what's happening in residential aged care facilities? Australasian Journal on Ageing, 21, 123–127.CrossRefGoogle Scholar
Schier, J. G., Howland, M. A., Hoffman, R. S. and Nelson, L. S. (2003). Fatality from administration of labetalol and crushed extended-release nifedipine. Annals of Pharmacotherapy, 37, 1420–1423.CrossRefGoogle ScholarPubMed
Strachan, I. and Greener, M. (2005). Medication-related swallowing difficulties may be more common than we realise. Pharmacy in Practice, 15, 411–414.Google Scholar
Tissot, E. et al. (2003). Observational study of potential risk factors of medication administration errors. Pharmacy World of Science, 25, 264–268.CrossRefGoogle ScholarPubMed
Treloar, A., Beats, B. and Philpot, M. (2000). A pill in the sandwich: covert medication in food and drink. Journal of the Royal Society of Medicine, 93, 408–411.CrossRefGoogle ScholarPubMed
Wright, D. (2002a). Medication administration in nursing homes. Nursing Standard, 16 (42), 33–38.CrossRefGoogle ScholarPubMed
Wright, D. (2002b). Tablet crushing is a widespread practice but it is not safe and may not be legal. Pharmaceutical Journal, 269, 132.Google Scholar
Wright, D. et al. (2006). Consensus guidance on the medication management of adults with swallowing difficulties. In Foord-Kelcey, G. (ed.), Guidelines – Summarising Clinical Guidelines for Primary Care. 30th edn (pp. 373–376), Berkhamsted: Medendium Group Publishing Ltd.Google Scholar