Reflective log 24.05.13 Crushing tablets

Reflective log: Severe expressive aphasia and apraxia of speech

1. Think of a recent therapy session or event.

One of my patients was refusing to swallow her medication to the extent that it affected her I and R levels. I mixed crushed medication with some yogurt since it was bitter and a very thick consistency so hard for the patient to swallow. I thought that as the medication was crushed already it would be alright to mix it with yogurt. I then spoke to my supervisor and a pharmacologist about crushing medication.

2. Describe the session/experience

My supervisor advised me not to get involved in administering medication since crushing medication/ giving it with substances other than water affects its properties.

3. What did this session make you feel?

I felt concerned that I had got involved in a clinical area without clearly consulting guidelines and my clinical responsibility.

5. What has this session has taught you?

- To contact the pharmacist if I have any questions about the administration of medication.

- To keep to providing advice about what the patient may be able to swallow but not becoming actively involved in the administration of medication.

6. What will you do before the next session?

- Contact the pharmacologist to ask questions concerning the crushing and administration of medication.

Interview with the Pharmacist

PO - on drug chart means orally administered (other routes: rectal, transdermal e.g. hyoscine, sublingual, parenteral).

SLT assessment - we advise on whether a patient can 1) chew drugs and 2) whether they can swallow tablets.

NG tubes = thinner tube than PEG tubes so can be more difficult to give medicines through.

Carers - should only give medicines from a dosset box.

Bioavailability 
Percentage of the administered dose that reaches the patient's systemic circulation. Altered by formulation e.g. route of administration since drugs can be metabolised by GI bacteria/ GI mucosa/ liver before reaching systemic circulation.

•  Drugs which have a modified/ sustained release cannot be crushed since this will affect their   pharmacokinetics.
• Liquid preparations are available for some medications but are expensive.
• Medications are not licenced if they are crushed.
• Tablets with a ridge for breaking in the middle are unlikely to be sustained release.
• Some drugs should not be mixed with yogurt/ juice since acidity may cause a chemical reaction.
•  Dispersing is a better option than crushing tablets i.e. put the tablet in water and mix.

·      www.medicines.org.uk – click on the drug name to get specific administration information.

·      The pharmacologist is going to research if thickener is safe to be mixed with medication.