181 Pharmacist Review of Clinical Practice for Crushing Medicines on Two Gerontology Wards in an Acute Hospital

Background Older patients frequently have difficulty swallowing, due to acute pathologies or chronic conditions. Tablets are often crushed and administered by various methods. This alters the licensed status of the medicine and, in some cases, crushing medicines poses iatrogenic risks to both patients and nursing staff. This study evaluated the prevalence of swallowing difficulties which impact the administration of medicines and assessed current practice in this area. Methods On a single day, clinical pharmacists reviewed all patients on two wards. The pharmacists, together with Nurses and Speech and Language Therapists, reviewed each patient. Patients receiving crushed medicines were identified and the reasons for crushing were established. Each relevant medicine was reviewed to assess suitability for crushing. STOPP/START criteria were used to assess for potentially inappropriate prescribing and continued need for each medicine. Results The study included 48 patients. Six (12.5%) were receiving crushed medicines due to swallowing difficulties/enteral feeding tubes. Prior to the review, the pharmacists were aware that two (33%) of these patients were receiving crushed medicines. The medical teams were not aware that the remaining four patients were receiving crushed medicines. The six patients were prescribed 48 oral medicines in total. 36 (75%) were being crushed while 12 (25%) were being administered in a suitable licensed formulation (liquid/dispersible tablet). The pharmacists confirmed that 24 (67%) were appropriate for crushing but recommended adjustment in 12 (33%) instances: 8 (22%) were available in a suitable alternative formulation and crushing was contraindicated in 4 (11%) instances (sustained release/enteric coated preparations). Additionally, STOPP/START criteria identified 6 (12.5%) of medicines as potentially inappropriate and requiring clinical review. Conclusion Administration of medicines in patients with swallowing difficulties was sub-optimal. Clinical pharmacist review of medicines supports appropriate administration in these patients. A system to promote close communication within the multi-disciplinary team regarding patient’s swallowing ability is needed.