Residents who cannot or will not swallow solid medication forms present challenges for healthcare professionals (HCPs) as they strive to maintain medication compliance in order to decrease morbidity and mortality.2
Explore our
LTC Portfolio brands
Eliminating the need to crush pills:
Medications designed with LTC residents and staff in mind
Eliminating the need to crush pills:
Medications designed with LTC residents and staff in mind
The Sun LTC Portfolio is designed to improve medication administration processes for residents who experience issues swallowing solid medications. These sprinkle formulations treat chronic conditions to facilitate resident engagement opportunities, healthcare professional efficiency, and focus
on care.
Actor portrayal.
Risk of developing swallowing difficulties increases with age and exposure to age-related conditions1
Swallowing difficulties have been associated with complications such as pneumonia, dehydration, and malnutrition2
Poor medication adherence puts patients with chronic illnesses at serious risk of negative and sometimes irreparable health decline.3 Medications are often crushed to ease administration for residents who have issues swallowing solid medications.4,5
However, crushing medications on the “Do Not Crush” list can result in medication errors.4,6 For long-term care (LTC) residents who cannot or will not swallow solid medication forms, an alternative formulation for oral administration or an alternative route of administration should be considered.4
Medication manipulation has inherent risks
Medication errors in LTC facilities can be caused by manipulation of medications
• For example, crushing tablets on the “Do Not Crush” list can alter the pharmacokinetic properties, therapeutic efficacy, and safety profile of the medication4,6
• Ingesting crushed tablets can place residents at risk for gastrointestinal adverse events and mucosal damage7
Medication errors can result in deficiency violations for LTC facilities
• To prevent F-tag 759 and F-tag 760 deficiency violations, LTC facilities must ensure that medication error rates stay below 5%, including no significant medication errors8
• An F-tag for “medication errors” can be issued if LTC residents are mistakenly administered crushed medications that should not be crushed8
Guidelines and standards have been issued to minimize the potential for medication error
• The Joint Commission International Accreditation Standards for Long Term Care urges facilities to dispense medications in forms that require minimal manipulation9
• The USP General Chapter <800> states that “Healthcare personnel should avoid manipulating hazardous drugs such as crushing tablets or opening capsules if possible”10
Medication manipulation risks by the numbers
Medications are often crushed to ease administration for LTC residents but that comes with limitations and risks.4
Approximately
400
medications are on the “Do Not Crush” list;
if these are crushed, their pharmacokinetic, efficacy, and safety profiles can be altered4,6
In a chart audit of 306 LTC residents across 4 sites in the United States,
about 38% of residents who received crushed medications received medications considered “inappropriate to crush”11
An estimated
700,000
adverse events occur each year in LTC facilities in the United States as a result of preventable medication errors12,13
6
common errors6,12
Medication errors include:6,12
- X
Dose omission
- X
Inaccurate dosing
- X
Wrong resident
- X
Wrong product
- X
Wrong strength
- X
Crushing medication that
shouldn’t be crushed
References: 1. Daggett VS. Managing dysphagia in elderly patients. Am Nurse Today. 2011;6(3):1-4. 2. Carnaby-Mann G, Crary M. Pill swallowing by adults with dysphagia. Arch Otolaryngol Head Neck Surg. 2005;131:970-975. 3. Harrison E. The cost of not taking our medicine: the complex causes and effects of low medication adherence. Am J Accountable Care. 2018;6(4):e11-e13. 4. Thong MW, Manrique YJ, Steadman KJ. Drug loss while crushing tablets: comparison of 24 tablet crushing devices. PLoS ONE. 2018;13(3):e0193683. 5. Hughes PF, Freeman MK, Slaton RM. Common issues in the medication use processes in nursing homes: a review of medication use quality improvement strategies. J Nurs Educ Pract. 2016;6(7):81-90. 6. Therapeutic Research Center. Meds that should not be crushed. Pharmacist’s Letter. https://pharmacist.therapeuticresearch.com/Content/Segments/PRL/2014/Aug/Meds-That-Should-Not-Be-Crushed-7309 7. Logrippo S, Ricci G, Sestili M, et al. Oral drug therapy in elderly with dysphagia: between a rock and a hard place. Clin Interv Aging. 2017;12:241-251. 8. Centers for Medicare and Medicaid Services. State Operations Manual Appendix PP - Guidance to Surveyors for Long Term Care Facilities. 2017;173:1-749. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf. Accessed April 25, 2022. 9. Joint Commission International. Joint Commission International Accreditation Standards for Long Term Care. 1st ed. Oak Brook, IL: Joint Commission International; 2012. 10. NIOSH [2023]. Managing hazardous drug exposures: information for healthcare settings. By Hodson L, Ovesen J, Couch J, Hirst D, Lawson C, Lentz TJ, MacKenzie B, Mead K. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2023-130, https://doi.org/10.26616/NIOSHPUB2023130. 11. Antimisiaris DE, O’Brien JG. A survey of inappropriate medication crushing in long term care. JAMDA. 2011;12(3):B4-B5. 12. Pierson S, Hansen R, Greene S, et al. Preventing medication errors in long-term care: results and evaluation of a large scale web-based error reporting system. Qual Saf Health Care. 2007;16:297–302. 13. Institute of Medicine. Report brief: preventing medication errors. Washington, DC: National Academies Press; July 2006.
Actor portrayal.
