Crushing oral solid drugs: Assessment of nursing practices in health-care facilities in Auvergne, France

Nurses' knowledge and practice regarding mixing medications with food: a multicenter cross-sectional study from a developing country

BACKGROUND

Different pharmaceutical characteristics of the dosage form (DF) have a direct effect on how easily oral solid medicine is swallowed. The practice of crushing tablets or opening the capsule occurs daily in the hospital, and most nurses are unknowledgeable regarding these issues. Coadministration of medications with food can cause changes in drug absorption and lead to an alteration in gastrointestinal motility, which can cause an unexpected effect on the dissolution and absorption of the drug. Therefore, this study aimed to investigate nurses' knowledge and practices regarding the mixing of medications with food or drink in Palestine.

METHODS

From June 2019 to April 2020, a cross-sectional study was conducted, encompassing nurses working in government hospitals across various districts of Palestine. The data were collected through face-to-face interviews, using questionnaires that assessed nurses' understanding and implementation of mixing medications with food. The sampling method employed was convenience sampling. To analyze the gathered information, the Statistical Package for the Social Sciences version 21 (IBM-SPSS) was utilized.

RESULTS

A total of 200 nurses participated in the study. The data show a significant difference between the median knowledge scores according to the department of work (p < 0.001). The highest median [interquartile] knowledge score of 15 [12-15] was found for nurses working in the neonatal intensive care unit. In addition, nurses in the pediatric ward and the men's medical ward had high scores of 13 [11.5-15] and 13 [11-14], respectively. In general, the results show that 88% of nurses modified oral DF prior to administration to patients. Regarding the type of food used, mixing medicine into juice was the most common procedure performed by nurses (approximately 84%); 35% of nurses used orange juice to mix with medicine. The most common reason for crushing was to administer medications to patients with a nasogastric tube (41.5%). In regard to medications, aspirin was the most frequently used drug that was crushed by the nurses (44%); however, 35.5% of nurses did not feel sufficiently trained to carry out this practice. Concerning the sources of information, 58% of nurses usually asked pharmacists for information about medications.

CONCLUSIONS

The results of this study show that crushing and mixing medications with food is common among nurses, and most nurses are unaware of the dangerous effect of this practice on patient health. Pharmacists, as medication experts, should participate in sharing knowledge about unnecessary crushing situations or when crushing should be avoided and try to find an alternative, when available, to aid administration.

Development and validation of the INappropriate solid oral dosaGE form modification aSsessmenT (INGEST) Algorithm using data of patients with medication dysphagia from a neurology ward and nursing home in Singapore

OBJECTIVES

This study aims to develop and validate a novel implicit tool to assist clinicians in resource-limited settings to promptly assess suitability for modification of solid oral dosage forms (SODFs) during medication prescribing, review and/or administration for patients with dysphagia.

DESIGN

Literature review and a group discussion were conducted to elicit items for the construction of the INappropriate solid oral dosaGE form modification aSsessmenT (INGEST) algorithm. For its validation, inter-rater reliability among three independent users was evaluated. Accuracy of users' ratings was also evaluated against the screening results using the Don't Rush to Crush handbook.

SETTING AND PARTICIPANTS

Three pharmacists were involved in the development and another three were involved in the validation of the INGEST algorithm using anonymised medication records of 50 patients in a nursing home and a hospital ward; only SODFs that were modified prior to administration were evaluated.

RESULTS

Following literature review, considerations included by consensus in the INGEST algorithm were the presence of special coating or modified release characteristics of the SODF medications, hazardous nature and taste of the active ingredients, manufacturer's advice and use of tube feeding. Of the 381 SODF medications evaluated, 26 (6.8%) were identified by at least one pharmacist to be inappropriate for modification. Gwet's AC among the three pharmacists in identifying SODF medications inappropriate for modification was 0.75 (p<0.001, 95% CI 0.63 to 0.87), and 0.80 (p<0.001, 95% CI 0.71 to 0.89) in identifying SODF medications appropriate for modification, suggesting substantial inter-rater agreement. Overall accuracy of each pharmacist's ratings was high, ranging from 93.7% to 95.6%.

CONCLUSIONS

The implicit INGEST algorithm has potential for use by clinicians in nursing home and hospital settings for determining suitability of SODF medications for modification. Further studies should be conducted to assess its external validity and utilisation in daily practice for improving clinical outcomes for patients with SODF dysphagia.

A description of dry oral forms of medication administration modifications by nurses in home settings

Modifying the galenic of dry oral forms (DOF) to be administered to patients with swallowing or behavioral disorders is frequent in long term care homes. The objective was to investigate the practice of modifying DOF galenic by nurses in home settings (NHS). A 14-question electronic survey was distributed to 1977 NHS. Almost 3/4 of respondents reported crushing tablets or opening capsules, with 37% on a daily basis. Approximately 22% did not inquire about the feasibility of modifying galenic DOF beforehand. Nearly 75% of NHS were aware about the risk of ineffectiveness after crushing tablets or opening capsules. However, only 14% mentioned the risk of overdosing associated with this practice. More than 60% of NHS never wore protective equipment when changing dosage form. Changing the dosage form of DOF is a widespread practice in home settings. Our present work urges the need to improve collaboration between prescribing physicians, nurses and pharmacists.

Registered Nurses' medication administration skills: a systematic review

AIMS

The aim of this review was to identify methods for measuring Registered Nurses' medication administration skills and to describe these skills.

DESIGN

A systematic literature review.

DATA SOURCES

The CINAHL, PubMed, Scopus, Cochrane, PsycInfo and Medic databases were searched for articles from the period 2007-2018.

REVIEW METHODS

Two researchers independently selected the articles and evaluated their quality using the National Heart, Lung and Blood Institute study quality assessment tools. The data were analysed using content analysis.

RESULTS

A total of 727 studies were identified of which 22 studies were included in this review. A total of six different measurement methods were identified: questionnaire or survey, observation, knowledge test or exam, focus group interviews, chart reviews and voluntarily reported errors. Different methods provided different information on medication administration skills. Medication administration skills were classified under nine areas: (1) safe ordering, handling, storing and discarding of medications, (2) preparing of medications, (3) the administration of medications to patients, (4) documentation, (5) evaluation and assessment of medication-related issues, (6) drug calculation skills, (7) cooperation with other professionals and (8) with the patients and (9) reporting of medication information. The results demonstrated that there are many areas that need to be improved to increase medication safety.

CONCLUSIONS

Medication administration includes many different phases, as a result of which nurses need to have many various skills to cope with medication administration as required by their profession. This review shows that nurses' medication administration skills need to be developed, and special attention should be paid to the preparation and administration phases. It is important to regularly utilise different teaching strategies and verify nurses' medication competence. As each research method has different limitations, it is vital that further studies combine different methods to form a comprehensive picture of nurses' medication administration skills.

Thickened Drinks and Oral Nutritional Supplements as Potential Reservoirs of Oral Microorganisms: Microbial Assays In Vitro

Oral hygiene is difficult to achieve for frail older adults. Aging, chronic diseases, polypharmacy, mouth-washes, and crushed drugs can contribute to uncontrolled proliferation and microbial deposits in the mouth. Looking for avoidable risk factors, in vitro microbial survival or proliferation in thickened drinks and oral nutritional supplements (ONS) was investigated. The safest thickened drinks were ready-to-use products containing preservatives. Escherichia coli, Staphylococcus aureus, and Candida albicans proliferated in dairy ONS at room temperature. C. albicans also proliferated in juices. Oral anerobic bacteria were recovered from part eaten ONS. Thickened drinks and ONS could contribute to microbial proliferation, especially with patients who have swallowing alterations or cognitive troubles, who may keep these solutions longer than necessary in their mouth. These products can also constitute microbial reservoirs in the environment of frail older adults. It is important for health care workers and family members to respect hand hygiene and refrigeration procedures. [Research in Gerontological Nursing, xx(x), xx-xx.].

In Vitro Screening of the Antibacterial and Anti-Candida Properties of Crushed Nonantimicrobial Drugs Frequently Prescribed in Nursing Homes

Frail older adults often experience swallowing disorders, prompting nursing staff to crush tablets, open capsules, and mix drugs into their meals or gelled water. However, crushing drugs can lead to pharmacological and gustatory problems. As crushed drugs can stay in prolonged contact with oral microbial biofilm, the current study aimed to investigate their antimicrobial properties. Crushed drugs were diluted in 1 mL of isotonic water and assayed in vitro for: (a) growth inhibition of five bacterial strains and Candida albicans by the diffusion method; (b) inhibition of Streptococcus salivarius and C. albicans biofilm formation; and (c) elimination of a preformed biofilm of S. salivarius and C. albicans after 5-minute contact. Eight of 29 crushed drugs inhibited bacterial and/or fungal growth on agar plates. Twenty-eight of 29 crushed drugs reduced the total biomass when incubated with S. salivarius, and 28 of 29 crushed drugs inhibited C. albicans biofilm formation. Preformed biomass was reduced by ≥25% by seven of 29 drugs. Crushed drugs may unbalance oral ecosystems and contribute to oral inflammation. [Res Gerontol Nurs. 2018; 11(2):82-90.].