The Pharmaceutical Journal
Vol 270 No 7235 p179
8 February 2003

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

Guidance issued by pharmacist on how to administer medicines to patients with swallowing difficulties

Guidance for nurses and carers who administer medicines to patients with swallowing difficulties has been produced by Dr David Wright, lecturer in pharmacy practice at the University of Bradford.

Published in Nursing Standard, the protocol is designed to help health care staff who may need to crush or open medicines before they are administered (2002;17:43).

The protocol explains that opening a capsule or crushing a tablet before it is administered to a patient will, in most cases, make its use unlicensed. Dr Wright advises that this practice should only be carried out if the prescriber has given written authorisation and the nurse or person in charge has no concerns about patient or carer safety.

"Tablet tampering may compromise patient safety and 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. The protocol has been formulated to help nurses achieve best practice in administering medication to people with swallowing difficulties," said Dr Wright.

The protocol includes a list of medicines that should never be crushed or opened — modified release preparations, enteric coated tablets, hormonal, cytotoxic and steroidal medicines, and nitrate preparations. It also gives reasons for not crushing or opening these types of medicines.

Flow charts provide information on how to deal with swallowing difficulties in the short and long term and also give guidance on administering medicines via percutaneous endoscopic gastrostomy or jejunostomy tubes.

Publication of the protocol follows research conducted by Dr Wright that showed tablet crushing is widespread, with the practice taking place in over 80 per cent of nursing homes at least weekly (PJ, 6 July 2002, p8).

Pharmacists who would like a copy of the protocol should send an e-mail to jspr@blueyonder.co.uk stating whether they would prefer to receive an electronic or paper copy of the protocol.