Background Medication use in nursing homes is considerable and the prevalence of dysphagia and other impairments is significant. This can affect the administration of medications in their oral form (tablets, capsules, etc.). The crushing of medications and/or mixing them with food can change the quality of a drug.

Purpose The aim of this study was to investigate the status of drug administration with special focus on the crushing of drugs.

Materials and methods The study was conducted in two selected nursing homes. Two wards at each nursing home were visited on four consequtive days. The study population was sorted by age,sex,and cognitive status. The nurses were observed as they prepered and administered the medication. The type of drugs and their number were documented. It was also recorded if tablets were split or crushed and if capsules opened or crushed. The mixing of medications with food was noted.

Results Participants were 73, females 49 (67%). Preparation of 1917 drugs for 522 instances of drug administrations were observed. A majority (54%) of drugs administered during the study period were crushed, a common practice among nurses if the residents had problems swallowing. Tablets/coated tablets and tablets with extended release were crushed in 61% and 39% of cases respectively. Acid resistant coated tablets and capsules were crushed in 54% and 29% of cases respectively. The most common food item used for mixing medication was apple puree.

Conclusions Considerable amount of drugs during this observation can be expected to have been made ineffective or change quality in crushed form. Drug safety and efficacy was thus compromized and resources wasted. Published recommedations for proper drug handling and suggestions for alternative drug forms for patients with dysphagia proved to be limited. A list was constructed of medications that should not be crushed and cases noted where a more appropriate dosage form was available.