The Pharmaceutical Journal
Vol 269 No 7205 p8
6 July 2002

This article
Reprint
Photocopy

News summary

Related websites
Nursing Standard (www.nursing-standard.co.uk)

Tablet crushing by nurses widespread

The practice of crushing tablets is widespread in nursing homes in the United Kingdom, with 84 per cent of nurses having crushed tablets or opened capsules for patients over the past 12 months, according to Dr David Wright, lecturer in pharmacy practice at the University of Bradford.

Dr Wright warns: "The crushing or opening of medication results in unlicensed administration with the liability lying solely with the nurse if unauthorised or shared with the prescriber if authorised." He advises that nurses should, as an absolute minimum, seek advice from a pharmacist before crushing medicines.

Dr Wright has shown that crushing tablets or opening capsules in response to swallowing difficulties or for administration via enteral feeding tube takes place in over 80 per cent of nursing homes on at least a weekly basis. "With the availability of most oral medicines as a liquid formulation, the majority of reported crushing or opening that is taking place is unnecessary," he says.

A sample of 540 nurses working in nursing homes completed a questionnaire about how they administer medicines and the problems they face.

They reported that, on average, 15 per cent of nursing home residents had difficulty swallowing tablets and capsules and that 5 per cent regularly spat out their medicines.

Nurses responded to these difficulties by mixing medicines with food (56 per cent of nurses), omitting the dose (27 per cent) and tablet crushing (61 per cent).

Most nurses said they would be willing to ask the prescriber for a liquid alternative but over half stated that the prescriber might recommend that medicines be crushed or opened.

In the study, 82 per cent of nurses said they would consult a pharmacist if advice was needed but 10 per cent said that they never sought advice before crushing tablets or opening capsules (Nursing Standard 2002;16:33).