By Matthew Burnette, PharmD, Gayco Director of Clinical Operations and Consultant Pharmacist
Crushing or opening medications for administration, is a practice affecting many residents across all long-term care settings. This practice is performed during the medication pass and occurs when the facility employee takes a tablet or capsule and crushes or opens that medication to be mixed with another substance, usually pudding, and administered to the resident. There are a variety of reasons why this may occur such as tablet size, difficulty swallowing, cognition deficits, or simply patient preference. Most States and practice settings require that a physician review the patient and write a “crush medication order” prior to allowing this practice for an individual. This is a key step in the process, but there are others that will add additional benefits for patients. The single most important suggestion I can make is to contact your Pharmacist when the order to crush medications is first written. The Pharmacist will be able to review each resident’s specific medication list and verify if all of their medications are suitable for crushing.
This communication is key to ensuring that patients are receiving the highest quality of healthcare. If a medication is not suitable to be crushed there can be very serious effects from doing so. A simple example would be crushing a tablet that is created as an “extended-release” version. Drug manufacturers use a variety of ways to make a medication “extended-release” and most of them will be drastically affected if the tablet is damaged prior to being swallowed. There could be a sudden release of too much drug leading to negative side effects, or the medication could not have enough time to have an effect before it is cleared away by the body. This leads to a loss of benefit and negatively affects the patient’s quality of life. Capsulized medications are similar to extended-release tablets as the capsule itself can be used to control the release of the appropriate dosage over time. This mechanism can be altered if the capsule is opened and the contents are poured out to be administered.
Medication dosage forms and administration routes is a complex issue that requires the expertise of multiple healthcare professionals from the interdisciplinary team. A quick phone call to your friendly Pharmacist can have a positive impact on your patient’s care by providing the vital information needed for the care team to make decisions.