4CPS-160 Management of drugs in patients with swallowing difficulties in a public residential care home: role of the hospital pharmacist

Background and importanceInstitutionalised people in a nursing home have a profile characterised by advanced age, multiple pathologies and many also suffer from swallowing problems. This not only affects nutrition but can also affect taking medications. Many drugs must be crushed or dissolved to facilitate administration and in many cases the stability of the drugs under these conditions is not known.Aim and objectivesThe aim of the study was to evaluate medication administered to patients with swallowing problems in a public residential care home and to establish possible commercialised alternatives or develop compounding pharmaceutical preparations.Material and methodsA prospective longitudinal study was performed (1 month) in a public nursing home. Data collected were: patients with swallowing difficulties and oral treatments which had to be subdivided or crushed for administration, nasogastric tube use, age, sex, number of drugs and pharmaceutical forms. We also did a literature search for drugs and use in this manner (small therapeutic windows, slow release, enteric coats, etc) to look for alternatives that might facilitate administration and guarantee stability and safety.ResultsEighty-five institutionalised elderly patients lived in the nursing home and 20% had dysphagia or difficulty taking their oral treatment. Mean age of the patients with swallowing difficulties was 90.35 (SD=4.27) years. None had a nasogastric tube. Fifty-three different medications were identified and only 11 had an adapted pharmaceutical formulation: 50% (26/53) had an alternative of the same composition but of a different pharmaceutical form commercialised as syrup, oral solution, drops or powder. In 47 cases the drugs could be crushed and diluted and administered immediately. In five cases the drugs were being crushed and should not have been. The pharmacist proposed other alternatives, such as drinking parenteral ampoules (5/53), sublingual administration (1/53) or elaborate compounding preparations (8/53). The possibility of preparing eight compounding pharmaceutical preparations was facilitated.Conclusion and relevanceMost of the treatments that were analysed did not facilitate swallowing and were manipulated, which can provoke errors in medicine administration. Hospital pharmacists should assess the suitability of compounding medication formulations and propose solutions to guarantee stability and safety of medicines.References and/or acknowledgementsNo conflict of inte