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Medication administration in nursing homes.

David Wright1

  • 1School of Pharmacy, University of Bradford. d.wright@bradford.ac.uk

Nursing Standard (Royal College of Nursing (Great Britain) : 1987)
|September 10, 2002
PubMed
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Many nursing home residents struggle with swallowing oral medications. Crushing or opening pills, an unlicensed practice, is common, often unnecessarily, due to prescriber reluctance for liquid alternatives.

Area of Science:

  • Geriatric Pharmacy
  • Nursing Home Care
  • Medication Administration Safety

Background:

  • Swallowing difficulties (dysphagia) are prevalent in nursing home residents.
  • Administering oral medications to patients with dysphagia presents significant challenges.
  • Ensuring safe and effective medication delivery is critical in long-term care settings.

Purpose of the Study:

  • To identify challenges in administering oral medications to nursing home residents with swallowing difficulties.
  • To document current methods used to overcome these administration challenges.
  • To assess the appropriateness and implications of these methods.

Main Methods:

  • A self-administered questionnaire was distributed to 763 nurses in independent nursing homes.

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  • Data collected included demographics, methods for overcoming swallowing difficulties, and opinions on liquid formulations.
  • Response rate was 70.8% (540 completed questionnaires).

    • Main Results:

    • 15% of residents had difficulty swallowing pills; 5% regularly spat out medication, 1% hid it.
    • Common methods included hiding medication in food (56.5%), dose omission (26.9%), and crushing/opening pills (61.3%).
    • 87.6% obtained liquid alternatives, yet crushing/opening (unlicensed administration) occurred weekly in over 80% of homes, often due to prescriber reluctance and cost concerns.

    Conclusions:

    • Crushing or opening medications constitutes unlicensed administration, carrying liability for nurses and prescribers.
    • Much of this practice is unnecessary given the availability of liquid formulations.
    • Prescriber reluctance to switch to liquid forms contributes to unnecessary unlicensed administration; clear documentation is needed for authorized deviations.