Background Drug administration to patients with dysphagia/via feeding tubes is known to be very complicated. Modifying oral dosage forms may alter drug stability, pharmacokinetics and bioavailability, and harm patients. Manipulation of drug dosage forms may also influence the health of healthcare workers or caretakers.
Purpose The aim of the study was to obtain an overview of problems with modifying solid dosage forms and administration to patients with dysphagia or feeding tubes in different hospital wards.
Material and methods The data were collected over 3 weeks in February and March 2015. All patients with a nasogastric or gastrostomy tube or with dysphagia were included in the study once. Extraction of nursing records as well as interviews with nurses were used for data collection.
Results Administration of medications to 21 patients from 7 different wards was studied. 96 preparations of 64 different medications or dosages, which involved crushing or dissolving solid dosages, were identified. 77/96 administrated preparations should not have been modified. Preparation modification was documented by the nurses for 42/96 preparations. 6 of the 14 interviewed nurses decided on drug modification themselves and 8 nurses had involved the physician in the decision making. 13/14 nurses found that they had not faced any practical problems during drug administration. Regarding possible health risk of dosage form modification, 1 nurse admitted knowing that drug crushing/dissolving may be a potential health hazard, 11 nurses denied this possibility and 2 nurses had not thought about it before.
Conclusion Administration of a solid drug dosage form to patients with a nasogastric tube, gastrostomy tube or patients with dysphagia has many problems: 80% of all preparations were administrated incorrectly, only 44% of preparation modifications were documented and less than half of the nurses involved the physician in the decision making process. There is a need for implementation of local guidelines for drug administration via feeding tubes, to patients with dysphagia and for personnel training.
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