The Pharmaceutical Journal
Vol 271 No 7262 p204
16 August 2003

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Letters to the Editor

Tablet crushing

A pragmatic approach recommended

From Ms J. A. Smyth, MRPharmS, and Mr S. Keeling, MRPharmS

We echo Rebecca White’s comment (PJ, 9 August, p174) that patients must not be denied essential drug therapy by preventing the crushing of tablets. The guidance from the British Association for Parenteral and Enteral Nutrition is a useful “how-to” guide covering methods of drug administration via enteral feeding tubes, and the main pharmaceutical and pharmacological problems associated with this. However, it is impossible to provide details of all the exceptions to the basic rules in such a concise guide.

At Wrexham Maelor Hospital we have developed a guide, now in its third edition, to the administration of drugs in patients with swallowing difficulties or enteral feeding tubes. As well as covering methods of administration, it contains monographs for over 180 drugs, with specific advice on dosage alterations, drug and route alternatives, drug-feed gaps and side effects related to enteral tube and crushed tablet administration.

The guide is available to nursing and medical staff on the wards as an A4 booklet, and to ward pharmacists as an A5 pocket book or Palm file.

We would recommend this pragmatic approach over a simple “do not do”, since in our experience this rarely works in practice.

Jennifer Smyth
Intensive Care Pharmacist and Editor of Drug Administration via Enteral Tubes Guidelines
Wrexham Maelor Hospital

Steve Keeling
Principal Pharmacist, Clinical Services.
Wrexham Maelor Hospital

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