Assessing the Rate of inappropriately Crushed Medications in Skilled Nursing Facilities

Purpose: Evaluate the impact of senior care pharmacists' medication management when a Do Not Crush (DNC) list is used to identify patients inappropriately receiving crushed medications. Methods: Participating senior care pharmacists retrospectively assessed skilled nursing residents with active medications on the DNC list for study inclusion. Study outcomes included assessing prevalence of residents with the inability to receive medications whole orally yet receiving DNC medication(s). Additional outcomes included prevalence rate of patients receiving DNC medications who also have enteral feeding tubing, nothing by mouth orders (NPO), or inability/unwillingness to swallow medications whole. Results: A total of 1,070 skilled nursing patients were reviewed with 778 meeting inclusion criteria. Of those 778 patients, approximately 27% were receiving inappropriately crushed medications. Of those patients, 90% warranted pharmacist intervention associated with a total of 473 medications. Females represented 67% of the patient population, and 90% of patients were 65 years of age or older. The average number of DNC medications was three per patient. The reasons for crushing medications varied. Four patients were classified as NPO, 13 had enteral feeding tubes, 130 patients could not physically swallow medications due to dysphagia, and 122 refused to receive medications whole. Conclusion: Senior care pharmacists can play an integral role in ensuring patients receive medications in accordance with manufacturer guidelines, safe medication practices, and use of alternative formulations as appropriate. The rate of inappropriately crushed medications administered in skilled nursing facilities is high at 27% in the present study. This rate could be further confounded because of the possibility of medications being crushed despite the fact that there is not an indication to do so in the patient chart.