Abstract
BACKGROUND: In geriatrics, drugs are frequently crushed or opened to facilitate their administration. However, these operations can lead to medication errors. PURPOSE: Evaluate medication crushing and opening practices in a residence for the elderly in order to identify corrective actions likely to improve such practice. MATERIAL AND METHODS: A prospective study was performed in a French university hospital residence comprising a nursing home and a long-term care unit (266 patients). Patients for whom treatment was crushed or opened were identified. Prescriptions and causes for crushing and opening drugs were analysed. Drugs and respective administration techniques were studied. Economic impact was not considered. RESULTS: One hundred patients with a mean age of 85 years were included. Medication crushing or opening concerned 38% of patients. On average, four drugs were crushed or opened per resident. The main reasons for crushing or opening drugs were swallowing disorders or psycho-behavioural distress. In 51% of cases, the decision to crush or open the drug was made by nurses without physician or pharmacist supervision. No nursing traceability of the act was found. The therapeutic classes most concerned by this practice were antipsychotics (23%), cardiovascular drugs (22%) and analgesics (14%). Fifty-two per cent of crushed or opened drugs (219 drugs) had a galenic presentation which did not allow crushing or opening (film-coated tablet (37%), gastro-resistant tablet (13%) and extended-release tablet (8%)). An alternative galenic presentation was available in 33% of cases but was not prescribed. Although medication crushing or opening was possible, a more suitable galenic presentation was available in 80% of cases. CONCLUSION: In our residence, medication crushing and opening practices are more important than those found in the literature.(1,2) However, the rest of our results are in accordance with the literature.(1–3) Corrective actions were developed in order to optimise elderly safety, a list of crushable drugs was given to geriatricians and nurses, and information signs about crushing or opening medication were displayed in each care unit. To optimise patient care, a review of prescriptions by a geriatrician and a pharmacist will be established to adapt prescriptions to the patients’ clinical situations and capacities. REFERENCES AND/OR ACKNOWLEDGEMENTS: 1. Rousseau A, et al. (2016). 2. Caussin M, et al. (2012). 3. Auffret M, et al. (2012). No conflict of interest