Nurses warned on 'crushing' tablets

The authors called for guidlelines for nurses

Nursing home staff regularly crush pills for residents with potentially harmful consequences, a report suggests.

A survey of 540 nurses has found that more than 80% crush or open medication at least once a week.

They do it when patients - particularly the elderly - have trouble swallowing the tablets whole.

But experts have warned that the policy could be harming patients because some drugs are designed with a coating which affects the way it is absorbed into the body.

Until there are clear guidelines for nurses and carers, countless lives are being unnecessarily put at risk

David Wright, University of Bradford

The authors of the report, published in Nursing Standard magazine, have called for guidelines for staff on when they can crush medication.

Some drugs are coated so that the active ingredient is released in the body over a long period of time, often 24 hours.

Crushing or opening the capsule in which the drug is contained means the drug is released a lot quicker than designed, potentially causing side effects.

Warning

The authors warned that there is no way nursing home staff can know which pills should not be opened before they are taken by patients.

A report from David Wright, a lecturer in pharmacy practice at the University of Bradford, found almost two out of three nurses admitted to crushing or opening medication themselves before giving it to residents.

They said they did it because in many cases residents have difficulty swallowing tablets or capsules.

It is also aimed at preventing patients from spitting out the medication or hiding pills.

In his report, Mr Wright said the practice could lead to legal problems for nurses.

"The crushing or opening of medication results in unlicensed administration with liability lying solely with the nurse if unauthorised."

In the survey, 58% of nurses said doctors, who originally prescribe the medication, had recommended crushing or opening.

But Mr Wright said: "Crushing may not be at all necessary, appropriate or safe."

He called for UK authorities to publish a list of which drugs should never be crushed or opened.

"Lists of medicines which may not be 'safely' crushed are regularly produced and updated in the USA and Canada.

"It is time for the UK to follow suit. Until there are clear guidelines for nurses and carers, countless lives are being unnecessarily put at risk."