AS A NUTRITION PHARMACY SPECIALIST, you are the go-to that nurses rely on for which mediations can be crushed, split, or given by an enteral tube. Follow these simple steps...
CAN THIS MEDICATION BE CUT OR CRUSHED? Educate that it's okay to crush most tabs withOUT a coating or modified-release. Recommend checking drug names for suffixes (CR, LA, SR, etc) to help spot modified-release medications.
Explain that scored tabs can usually be split. For example, point out that metoprolol succinate (Seloken Zoc) can be cut in half, even though it's extended-release. But evaluate splitting unscored medications on a case-by-case basis. For instance, lean away from cutting irregularly shaped tabs, such as rivaroxaban (Xarelto) 20 mg, this may lead to uneven dosing.
Tell nurses never to cut reservoir patches, such as nitroglycerin (Nitroderm) or any patch where exact dosing is critical, such as fentanyl (Duragesic). Explain that crushing some tabs, such as cefuroxime (Zinnat, Zinacef) or ciprofloxacin (Ciprofar, Ciprocin), may cause a bad taste. Emphasize following your hospital policy to cut or crush hazardous medications, such as finasteride (Proscar). For instance, remind nurses to check what personal protective equipment is needed.
CAN THIS MEDICATION BE GIVEN VIA A TUBE? Start by asking the nurse about the size and type of tube. For example, clarify that it's okay to open and administer some capsules (omeprazole, etc) and give some granules via a large-bore tube, with a diameter of 14 French or greater. But avoid with smaller tubes due to the risk of clogging.
And point out that a jejunostomy tube isn't a good route for medications absorbed higher in the intestine, such as some quinolones (levofloxacin, etc). Be alert for interactions between tube feedings and medications, such as with phenytoin (Ipantin, Epanutin). In this case, suggest another route or consider holding feedings one hour before and after the dose. Remind nurses not to mix medications with tube feedings and to flush before and after each medication with 15 to 30 mL of water. SEE VIDEO by RegisteredNurseRN about crushing medications for tube feeding and oral adminstration.
REFERENCES
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Williams NT. Medication administration through enteral feeding tubes. Am J Health Syst Pharm. 2008 Dec 15;65(24):2347-57. Available at: https://academic.oup.com/ajhp/article-abstract/65/24/2347/5129507?redirectedFrom=fulltext
Institute For Safe Medication Practices. (2018). Oral Dosage Forms That Should Not Be Crushed. [online] Available at: https://www.ismp.org/recommendations/do-not-crush
Lau ETL, Steadman KJ, Cichero JAY, Nissen LM. Dosage form modification and oral drug delivery in older people. Adv Drug Deliv Rev. 2018 Oct;135:75-84. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0169409X18300644?via%3Dihub
NT Contributor (2003). The administration of drugs via enteral feeding tubes | Nursing Times. [online] Nursing Times. Available at: https://www.nursingtimes.net/clinical-archive/nutrition/the-administration-of-drugs-via-enteral-feeding-tubes-18-11-2003
Gill D, Spain M, Edlund BJ. Crushing or splitting medications: unrecognized hazards. J Gerontol Nurs. 2012 Jan;38(1):8-12. Available at: https://journals.healio.com/doi/10.3928/00989134-20111213-01?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
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