PRACTICES FOR CRUSHING MEDICATION IN GERIATRIC UNITS Dr Duy NGHIEM - PowerPoint PPT Presentation

ASSESSMENT OF CLINICAL PRACTICES FOR CRUSHING MEDICATION IN GERIATRIC UNITS Dr Duy NGHIEM Charles-Foix Hospital (Paris)

CONFLICT OF INTEREST DISCLOSURE I have no potential conflict of interest to report

• Dysphagia among elderly patients • Crushing tablets and opening capsules  Potential iatrogenic risk • Assessment of daily practices in geriatric units

• 3 Southern Paris Hospitals • 17 geriatric units (526 patients) – long term, rehabilitation, acute care • Survey over a day

Prevalence of dysphagia Rehabilitation 24 % n = 46 Long term Difficulties care unit no difficulties 30% 40 % 70% n = 155 n = 98 n = 371 Acute 12 % n = 11

Prevalence of form modification 143 prescriptions studied 27,3% 72,7% UNSAFE n = 104 n = 39 At least 1 medication who full shouldn’t be modified conformity

Potential consequences 110 drugs prescribed and modified not documented Unsafe 27%, n = 30 safe to crush 52% 48% n = 57 health threatening (n= 53) 13%, n = 14 reduced efficacy 8%, n = 9

Known risks Overdose Mucosal irritation, Reduced efficacy Unpalatable taste, Reduced efficacy Teratogenic, Carcinogenic

Possibility for substitution Different galenic instructions not 11%, n=12 followed 4%, n=5 safe to No crush equivalent 52%, n = 57 33 %, n=36

Hygiene and Security No Yes Gloves n=26, 18% n=117, 82% Masks, Blouse n=143, 100% Use of a Mortar - n=143, 100% Cleaning between two patients n=7, 5% n=136, 95% Medications crushed one by one n=123, 86% n=20, 14%

Methods of administration Unnaceptable Acceptable n=30, 21% n=34, 24% (Laxatives) (water, jellyfied water) Questionnable n=79, 55% (cream, compote, yoghourt, juice, coffee, soup, puree)

• 30% of our patients suffers from dysphagia • Crushing medication can be harmful for staff/patients

• Geriatric assessment High prevalence • Crushing medication lists (OMEDIT) Prescriptions • specific notes in prescriptions app error Dangerous • Staff training • specific crushing devices practices Lack of • Studies • different galenic forms alternatives

2 simple rules • Is this drug really necessary ? • Switch to a more suitable form in the same therapeutic class

Thank you