Background The administration of oral medications seems the simplest and safest way to treat patients. But there is a group of patients who might struggle with it or cannot use commercial oral medication at all. These are the patients with dysphagia and the availability of suitable oral medications for these patients is a huge problem. This means, that often the tablets need to be crushed and capsules opened and this is, in many cases, unlicensed medication use and, in addition, might change the medications’ action.

Purpose The purpose of this study was to establish the size of the patient group in the studied wards and the medications administered to them.

Material and methods In 2016, there was a retrospective medication usage study in five hospital wards. The data were collected for all the patients with dysphagia that had oral medications administered on the same day. To check the possibility of crushing or dispersing these medications, the information from manufacturers (found in the Summary of Product Characteristics and asked for by e-mail) and two handbooks^1,2 was used.

Results One hundred and fifty-four patients were enrolled in the study: 114 from three intensive care units (most with nasogastric feeding tube) and 40 from nursing, therapy and rehabilitation treatment units. Four hundred and seventy oral medication administrations were recorded, 346 (74%) of them were administrations of tablets that needed crushing or dispersing prior to administration. Ninety-nine different medications were used and according to manufacturers information, only about 10% of the solid oral medications recorded in the study could be crushed or dispersed prior to administration.

Conclusion The oral administration of medications to patients with dysphagia is difficult and needs thorough thought concerning which medications are used and how they can be prescribed. These are definitely decisions where the special knowledge about the medication technology is very useful and therefore pharmacists should be more involved.

References

1. . White R, Bradnam V. Handbook of drug administration via enteral feeding tubes 2015(3rd ed.). Pharmaceutical Press.

2. . Smyth J. The NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties 2015(3rd ed.). North East Wales: NHS Trust.