Module 1: Crushing of Medication

Question 1

In what situations may alteration of medication be required?

Answer 1

Patients with swallowing difficulties

Patients with enteral feeding tubes

Question 2

What factors can lead to swallowing difficulties?

Answer 2

Age-related changes in salivary gland function
Medical conditions: stroke, parkinsons, MND
Young children
Dry mouth
Heavy sedation or loss of consciousness
Psychological barrier
redusal to take medicine due to deteriorating cognitive state
breathing difficulties

Question 3

What factors need to be considered before altering a solid dosage form of oral medication?

Answer 3

Are there any medications that cannot be modified?
Is there an alternative formulation available?
Is the medicine still required by the patient? Are similar meds available in a suitable dosage form?

Question 4

What is the procedure for crushing medication?

Answer 4

Document why the medication was altered.
Obtain written consent from consumer or legal guardian where possible.
Check if other formulation is already available, if the person needs that drug and if it is able to be crushed.
Wear PPE.
Do not crush cytotoxics outside of an approved cytotoxic cabinet.
Mortar and pestle should be placed on a waist high bench to ensure correct ergonomic technique and reduce overuse injuries.

Question 5

What types of medications should not be crushed?

Answer 5

Modified release preperations
extended release products
Sublingual preparations
film coated tablets
drugs with OHS concerns

Question 6

What are the medical implications of altering solid dosage forms?

Answer 6

May affect stability or efficacy of drug
Increased risk of toxicity
may cause unacceptable taste
proportion of dose may be lost when crushing or dispersing
Some may be left in crushing device or stuck to sides of medicine cup

Question 7

What are the OHS issues with crushing drugs?

Answer 7

Person crushing drug is exposed to the drug powder
exposure may lead to sensitisation, allergies, absorption and possible side effects.
Particularly of concern with cytotoxics or hormones.

Question 8

Describe the administration of an altered dosage form?

Answer 8

Do not use IV syringes to give oral or enteral medications.
Do not leave medicine drawn up in dispenser unlabelled and unattended.
Do not administer anything you have not prepared yourself, or have directly observed being prepared.
When a tablet or capsule has been dispersed in liquid, do not give a portion of the liquid as there may be uneven dispersion.
Be aware of the taste and texture of the altered medication
Give prepared medicine immediately
Document methods clearly
Do not mix medicines together
Prefereable to disperse a tablet rather than crush
If capsule has granules, do not crush.