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

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

Prevalence of form modification 143 prescriptions studied

72,7% UNSAFE

n = 104

At least 1 medication who shouldn’t be modified 27,3%

n = 39

full conformity

Potential consequences

safe to crush 52% n = 57 not documented 27%, n = 30 health threatening 13%, n = 14 reduced efficacy 8%, n = 9

Unsafe 48%

(n= 53)

110 drugs prescribed and modified

Known risks

Overdose

Mucosal irritation, Reduced efficacy Unpalatable taste, Reduced efficacy Teratogenic, Carcinogenic

Possibility for substitution

Different galenic 11%, n=12 instructions not followed 4%, n=5

No equivalent 33 %, n=36 safe to crush 52%, n = 57

Hygiene and Security

n=117, 82% n=143, 100%

• n=136, 95%

n=123, 86% n=26, 18% n=143, 100% n=7, 5% n=20, 14%

Medications crushed one by one Cleaning between two patients Use of a Mortar Masks, Blouse Gloves

No Yes

Methods of administration

Unnaceptable n=30, 21%

(Laxatives)

Questionnable n=79, 55%

(cream, compote, yoghourt, juice, coffee, soup, puree)

Acceptable n=34, 24%

(water, jellyfied water)

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

staff/patients

• Geriatric assessment
• Crushing medication lists (OMEDIT)

High prevalence

• specific notes in prescriptions app

Prescriptions error

• Staff training
• specific crushing devices

Dangerous practices

• Studies
• different galenic forms

Lack of alternatives

2 simple rules

• Is this drug really necessary ?
• Switch to a more suitable form in the same

therapeutic class

Thank you