Don’t rush to crush.

Many patients will be unable to swallow tablets due to medical conditions such as Parkinson’s disease, motor neurone disease, age related deterioration of salivary gland function. Others cannot swallow tablets simply because they have a lack of co-ordination or psychological aversion to it.

Before giving medications to these people careful assessment of each individual should be made to assess the possible risk of aspiration.
For patients that have recently experienced a stroke there is an ASSIST tool to help with initial evaluation of their swallowing functions.

For people with a simple aversion to swallowing tablets you could try to encourage them with these tablet swallowing techniques.

If there is no alternative other than to modify the medication in order to deliver it, be aware that some tablets should be crushed whilst others are best dispersed.

Always consult a drug manual such as the Don’t Rush to Crush Handbook for information on the correct method to deliver the individual medicine.

How to give a CRUSHED tablet.

  1. Crush the tablet to a fine powder using a mortar and pestle (or tablet crushing device).
  2. Mix the resulting powder with 10mls water.
  3. Draw the mixture into an oral dispenser (the orange coloured syringes dedicated for oral solutions) and shake well to mix.
  4. Give the solution immediately.

How to give a DISPERSED tablet.

  1. Remove the plunger from an oral dispenser.
  2. Place the tablet(s) into the syringe and replace the plunger.
  3. Draw 5–10mls of water into the dispenser and allow the tablet to disperse (dissolve). Gentle shaking may be required and it may take several minutes for maximal dispersion to occur. If left to disperse, a sediment may form and gentle shaking will be required prior to giving.
  4. Give the solution immediately.

NEVER draw draw oral medications into an intravenous syringe. There is a real risk of it inadvertently being given IV in some situations.

How to give in a THICKENED SOLUTION.

Patients at risk of aspiration due to swallowing difficulties may benefit from thickening the final solution. There are commercial thickening powders that can be used to achieve this.

How thick?
There are 3 level of liquid thickness recognised in Australia:

Level 150. Mildy thick liquids that would run freely through a fork but leave a coating on it.
Level 400. Moderately thick liquids that drip slowly in dollops through the fork.
Level 900. Extremely thick liquids that sit on the fork and do not run through it.

Advice should be sought from a speech pathologist as to the optimum level for individual patients condition.

VERY Important pearls.

  1. Administer each medication separately.
  2. Do NOT mix different medications together into one preparation as chemical incompatibilities may occur.
  3. Use water at room temperature. Warm or hot water may affect the medication.
  4. Equipment (e.g. motor and pestle) MUST be thoroughly washed and dried between patients.

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