Background Dysphagia is the most common oesophageal disorder in the elderly, particularly in patients living in institutional settings, such as nursing homes. Pharmacists have an important role in patient safety by suggesting alternative methods of administration, dosage forms or therapeutic agents that might be available in a more suitable formulation.
Purpose Implementation of individualised medicines administration guides for geriatric patients with dysphagia or enteral tube feeding.
Materials and Methods A total of 154 institutionalised patients were included in a transversal prospective study carried out in 2 nursing homes over a period of 6 months. A comprehensive geriatric assessment was performed by an interdisciplinary team and all patient medicines profiles were reviewed. Pharmacist recommendations and prescription adaptations were then used to write individualised medicines administration guides for all dysphagic patients.
Results Medicines administration problems were identified in 52 out of 154 patients (33.7%). Their mean age was 84.5 ± 9.2 years, and most of them were female (73.9%). Polypharmacy was high among this population (75%) as defined by taking more than five drugs (mean 6.6 per patient).
Dysphagia was the main problem for medicines administration (86.5%), while other factors such as blinded medicines (7.7%) or enteral tube feeding (5.8%) were less frequent.
The specialist pharmacist made 135 recommendations and prescription adaptations of which 94 (69.6%) involved changes on drug administration: crush tablets (42; 44.7%), change dosage forms (30; 31.9%), dissolve tablets and oral forms (11; 11.7%), change of therapeutic agent (9; 9.6%) and withdrawal of medicine (2; 2.1%). Acceptance among physicians and nurses of medicines administration guides for all 52 patients was high (98.9%).
Conclusions Pharmacists play an important role in adapting treatments of patients with dysphagia and feeding disorders, therefore ensuring safe administration of drugs. The implementation of individualised medicines administration guides supports individualised care and is generally well accepted.
No conflict of interest.
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