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Malouh MA, Sefidani Forough A, Cichero JAY, Lau ETL, Nissen LM, Steadman KJ. The prevalence and perceived effectiveness of using a medication-swallowing lubricant in aged care facilities across Australia. Aging Med (Milton) 2023; 6:239-244. [PMID: 37711253 PMCID: PMC10498827 DOI: 10.1002/agm2.12261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/15/2023] [Accepted: 06/18/2023] [Indexed: 09/16/2023] Open
Abstract
Objective To explore the extent of use and perceived effectiveness of using a medication lubricant that is specifically designed to help people who struggle to swallow their solid medications whole. Method Health care workers of varying professional levels in aged care facilities (ACFs) across Australia who are involved in medication administration were invited to participate in a structured online survey. Results Of the 355 health care workers who completed the survey, 48% had used the medication lubricant to aid administration of whole and/or crushed solid oral dosage forms, and of these 89% agreed with the statement that "it is effective method to facilitate medication swallowing in residents." The main benefits of using the medication lubricant were considered to be easier medication administration to residents (49%), reduction in need for crushing of medications (34%), and better adherence with medications (33%). Conclusions This study showed that using a medication lubricant for aged care residents may facilitate the process of medication administration for health care workers, which they perceive to improve residents' adherence with medications. Serious complications associated with solid dosage form modification may also be decreased by using a medication lubricant, as the need for modifying medications is reduced. Therapeutic Goods Administration (TGA)-approved medication lubricants could therefore be a valuable tool to aid the medication administration for patients who have difficulties swallowing medications. Future research may consider the clinical efficacy and acceptability of medication lubricants specifically for people with swallowing difficulties.
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Affiliation(s)
- Marwa A. Malouh
- School of PharmacyThe University of QueenslandBrisbaneQueenslandAustralia
| | - Aida Sefidani Forough
- School of Clinical SciencesQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Julie A. Y. Cichero
- School of PharmacyThe University of QueenslandBrisbaneQueenslandAustralia
- School of Clinical SciencesQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Esther T. L. Lau
- School of PharmacyThe University of QueenslandBrisbaneQueenslandAustralia
- School of Clinical SciencesQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Lisa M. Nissen
- School of PharmacyThe University of QueenslandBrisbaneQueenslandAustralia
- School of Clinical SciencesQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Kathryn J. Steadman
- School of PharmacyThe University of QueenslandBrisbaneQueenslandAustralia
- School of Clinical SciencesQueensland University of TechnologyBrisbaneQueenslandAustralia
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2
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Lee SV, Aplin T, Sefidani Forough A, Steadman KJ. Perceived Usability of Tablet Crushers: Comparison of Devices by People with and without Limited Hand Functions. Pharmaceutics 2023; 15:pharmaceutics15020517. [PMID: 36839840 PMCID: PMC9961238 DOI: 10.3390/pharmaceutics15020517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023] Open
Abstract
Tablet crushing is a common practice used by patients and their carers, mainly to facilitate swallowing. Various tablet-crushing devices with different designs are currently available on the market. This study aimed to compare the usability of different tablet-crushing devices in people with and without limited hand functions. The hand function of 100 adults recruited from the general community (40 of whom self-reported a limited hand function) was assessed using the hand and finger function subscale of the Arthritis Impact Measurement Scale version 2. The hand strength was measured using a dynamometer. Participants crushed tablets using 11 crushing devices and completed a Rapid Assessment of Product Usability and Universal Design questionnaire for each device. Hand-held twist-action crushers with an ergonomic grip received the highest usability scores among both groups, irrespective of the cost (p < 0.05). Crushers with bags were scored lower by those with limited hand functions, although the score improved if the device was automatic. Preferences regarding electronic crushers significantly changed once the cost was revealed. Economical twist-action crushers with ergonomic grips and without bags or cups were the most favoured crushers.
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Affiliation(s)
- Su Vin Lee
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Tammy Aplin
- School of Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, QLD 4032, Australia
| | - Aida Sefidani Forough
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Kathryn J. Steadman
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4072, Australia
- Correspondence:
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3
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Ilgaz F, Timur SS, Eylem CC, Nemutlu E, Erdem Ç, Eroğlu H, Gökmen-Özel H. Do Thickening Agents Used in Dysphagia Diet Affect Drug Bioavailability? Eur J Pharm Sci 2022; 174:106197. [PMID: 35489612 DOI: 10.1016/j.ejps.2022.106197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 04/01/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022]
Abstract
Swallowing oral solid dosage forms is challenging in patients with dysphagia who are at risk of aspiration or choking. The most common method to facilitate drug administration in dysphagia patients is to mix the powdered drug with a small amount of thickened water, however little is known about the effects of this method on in vivo bioavailability of drugs. This study aimed to evaluate the impact of thickened liquids on dissolution rate and bioavailability of levetiracetam as a model drug. Powdered commercial tablets of levetiracetam, carbamazepine, atenolol and cefixime were mixed with water thickened with two commercial thickeners, modified maize starch (MS) and xanthan gam (XG), at three thickness levels: nectar, honey and pudding in test groups, and mixed with only water in the control group. At the first stage, the effects of thickened water on in vitro drug release of 4 drugs (levetiracetam, carbamazepine, atenolol and cefixime) were tested by using dialysis membrane method. Addition of both thickeners significantly reduced the release of three drugs compared to the control group, except carbamazepine. Levetiracetam which had the highest solubility was chosen as the model drug for in vivo experiments. In the second stage, New Zealand albino female rabbits (n=24) were divided into two groups as: control group (water+drug, n=6) and test group (thickened water+drug, n=18). Powdered levetiracetam tablets were mixed with water thickened with XG (n=9, 1.2 %, 2.4 %, 3.6 %) and MS (n=9, 4 %, 6%, 8 %) at three thickness levels and administered to the rabbits by intragastric gavage. Blood samples were collected at 9 time points following administration. After two-weeks of wash-out, test groups were crossed over and sample collection was repeated. Blood samples were analysed using liquid chromatography with tandem mass spectrometry (LC-MS/MS). An in vitro-in vivo correlation (IVIVC) model was developed using in vitro drug dissolution (%) and in vivo plasma concentrations of levetiracetam for control group and test groups. The peak plasma concentration (Cmax) was lower and time to reach Cmax (tmax) was relatively higher in test groups compared to control group. The lowest Cmax was detected at the highest thickness level, however, the differences between groups were not statistically significant (p=0.117 and p=0.495 for Cmax and tmax, respectively). No significant difference in total amount of levetiracetam absorbed (AUC) was found between groups (p=0.215 and p=0.183 for AUCinfinity and AUClast, respectively). The comparisons according to the type of thickener also revealed that pharmacokinetic parameters did not significantly differ between groups, except for a significantly lower Cmax when drug was mixed with MS-thickened water at nectar consistency (1.2 %) compared to drug mixed with XG (4 %) at the same thickness level (p=0.038). A good correlation was observed between in vitro and in vivo data, which was characterized by higher r2 values as the concentration of the thickening agents was increased, but not for all thickness levels studied, indicating an inability of this in vitro model to fully predict the in vivo response. These results suggest that regardless of the thickness level, the administration of levetiracetam with two commercial thickening agents commonly used in dysphagia for safe swallowing, do not affect the pharmacokinetic efficiency and thus, the bioavailability of the drug.
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Affiliation(s)
- Fatma Ilgaz
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, 06100, Turkey.
| | - Selin Seda Timur
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, 06100, Turkey.
| | - Cemil Can Eylem
- Department of Analytical Chemistry, Faculty of Pharmacy, Hacettepe University, Ankara, 06100, Turkey.
| | - Emirhan Nemutlu
- Department of Analytical Chemistry, Faculty of Pharmacy, Hacettepe University, Ankara, 06100, Turkey.
| | - ÇiğdemEroğlu Erdem
- Department of Computer Engineering, Faculty of Engineering, Marmara University, Istanbul, 34722, Turkey.
| | - Hakan Eroğlu
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, 06100, Turkey.
| | - Hülya Gökmen-Özel
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, 06100, Turkey.
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4
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Lexow M, Wernecke K, Sultzer R, Bertsche T, Schiek S. Determine the impact of a structured pharmacist-led medication review - a controlled intervention study to optimise medication safety for residents in long-term care facilities. BMC Geriatr 2022; 22:307. [PMID: 35397527 PMCID: PMC8994296 DOI: 10.1186/s12877-022-03025-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/11/2022] [Indexed: 01/04/2023] Open
Abstract
Abstract
Background
Medication reviews contribute to protecting long-term care (LTC) residents from drug related problems (DRPs). However, few controlled studies have examined the impact on patient-relevant outcomes so far.
Objective
We examined the impact of a one-time, pharmacist-led medication review on medication changes (primary endpoint) including discontinued medication, the number of chronic medications, hospital admissions, falls, and deaths (secondary endpoints).
Methods
A prospective, controlled intervention study was performed in three LTC facilities. In the intervention group (IG), after performing a medication review, a pharmacist gave recommendations for resolving DRPs to physicians, nurses and community pharmacists. The control group (CG) received usual care without a medication review. (i) We assessed the number of medication changes and the secondary endpoints in both groups before (t0) and after (t1, t2) the intervention. (ii) Additionally, the medication review was evaluated in the IG with regard to identified DRPs, the healthcare professional’s feedback on the forwarded pharmacist recommendations and whether DRPs were finally resolved.
Results
107 (IG) and 104 (CG) residents were enrolled. (i) More medication changes were identified in the IG than in the CG at t1 (p = 0.001). However, no significant difference was identified at t2 (p = 0.680). Mainly, medication was discontinued in those medication changes. Chronic medications increased in the CG (p = 0.005) at t2 while hospital admissions, falls, and deaths showed no differences. (ii) Overall, 1252 DRPs (median: 10; minimum-maximum: 2–39) were identified. Recommendations for 82% of relevant DRPs were forwarded to healthcare professionals, of which 61% were accepted or clarified. 22% were not accepted, 12% required further review and 6% remained without feedback. 51% of forwarded DRPs were finally resolved.
Conclusions
We found more medication changes in the IG compared to controls. Mostly, medication was discontinued. This suggests that our intervention was successful in discontinuing unnecessary medication. Other clinical outcomes such as falls, hospitalisations, and deaths were not improved due to the one-time intervention. The medication review further identified a high prevalence of DRPs in the IG, half of which were finally resolved.
Trial registration
German Clinical Trials Register, DRKS00026120 (www.drks.de, retrospectively registered 07/09/2021).
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5
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Forgerini M, Lucchetta RC, Oliveira FM, Herdeiro MT, Capela MV, Mastroianni PDC. Impact of pharmacist intervention in patients with Alzheimer's disease. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e19876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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6
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Garratt SM, Jonas MF, Peri K, Kerse N. To crush, or not to crush? Unauthorised covert administration of medication in nursing homes. Int J Older People Nurs 2021; 16:e12393. [PMID: 34114361 DOI: 10.1111/opn.12393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 04/21/2021] [Accepted: 05/20/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES This study aimed to explore the experiences and perceptions of nursing home staff and residents of unauthorised covert administration of medication. Prior studies identify that covert medication administration (crushing medication to administer in food or drink) is common in nursing home settings. Still, few recognise that this practice may occur without consultation or clinical authorisation. DESIGN An exploratory qualitative study was conducted with nursing home staff and residents as part of a more extensive mixed-methods study on medication omissions and clinical decision-making. METHODS We conducted a qualitative study using focus groups and semi-structured interviews across four geographical areas in New Zealand to better understand nursing home staff and residents' experiences and perspectives on covert administration. Semi-structured interviews took place with 11 Clinical managers/leads and one senior Registered Nurse; role specific focus groups were held with Registered Nurses (n = 6), Health Care Assistants (n = 14), and Residents (n = 12). Data were analysed using thematic analysis. FINDINGS Participants described covert administration as a practical option if a nursing home resident refused medication but recognised it was a deception that carried ethical and clinical risks, particularly when unauthorised. Participants felt that unauthorised covert administration stemmed from doubts about residents' competence and the competing demands staff face during medication administration. Staff, who typically relied on advice from their pharmacies around which medications were safe to crush, expressed a need for more education. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE This study provides evidence that unauthorised covert administration of medications is an ongoing practice, using New Zealand nursing homes as an example. The results emphasise that nursing home staff and residents are aware that this practice carries ethical and clinical risks and requires a certified process to legitimise its authorised form.
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Affiliation(s)
- Stephanie M Garratt
- FMHS, School of Population Health, University of Auckland, Auckland, New Zealand.,National Ageing Research Institute, Melbourne, Vic., Australia
| | - Monique F Jonas
- FMHS, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Kathryn Peri
- FMHS, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Ngaire Kerse
- FMHS, School of Population Health, University of Auckland, Auckland, New Zealand
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7
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Solberg H, Devik SA, Bell HT, Zeiss DH, Olsen RM. Drug modification by nurses in Norwegian nursing homes: A cross-sectional study. Geriatr Nurs 2021; 42:351-357. [PMID: 33561616 DOI: 10.1016/j.gerinurse.2021.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
Crushing and dividing pills among older patients in nursing homes appears to be a common yet not harmless practice. Because few updates exist regarding the role of nurses and their dispensing of drugs in nursing homes, this study sought to describe the occurrence, methods, and causes of nurses' drug modification and to examine possible factors associated with drug modification in this context. A cross-sectional study of 273 dispensing episodes of solid oral drugs made by nurses, were observed during day and evening shifts. Modifications were made in 20.5% of the dispensing episodes, including 80.4% where alterations were made by crushing and 19.6% where alterations were made dividing. The most commonly reported reasons for modification were 'swallowing difficulties' (53.6%) and 'lack of understanding by the patient' (19.6%). The logistic regression analysis showed a significant association between the occurrence of drug modification and both cognitive impairment and administration method.
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Affiliation(s)
- Hege Solberg
- Faculty of Nursing and Health Sciences, Nord University, PO Box 474, 7801 Namsos Norway.
| | - Siri Andreassen Devik
- Centre for Care Research Mid-Norway, Nord University, PO Box 474, 7801 Namsos, Norway
| | - Hege Therese Bell
- Faculty of Nursing and Health Sciences, Nord University, PO Box 474, 7801 Namsos Norway; Faculty of Nursing and Health Sciences, Nord University, PO Box 93, 760 Levanger, Norway; Master in Pharmacy, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Høgskoleringen, 1, 7491 Trondheim, Norway
| | - Daniel Horst Zeiss
- Faculty of Nursing and Health Sciences, Nord University, PO Box 474, 7801 Namsos Norway
| | - Rose Mari Olsen
- Faculty of Nursing and Health Sciences, Nord University, PO Box 474, 7801 Namsos Norway
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8
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Chen EYH, Bell JS, Ilomäki J, Corlis M, Hogan ME, Caporale T, Van Emden J, Westbrook JI, Hilmer SN, Sluggett JK. Medication administration in Australian residential aged care: A time-and-motion study. J Eval Clin Pract 2021; 27:103-110. [PMID: 32285584 DOI: 10.1111/jep.13393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 01/05/2023]
Abstract
RATIONALE/AIM Medication administration is a complex and time-consuming task in residential aged care facilities (RACFs). Understanding the time associated with each administration step may help identify opportunities to optimize medication management in RACFs. This study aimed to investigate the time taken to administer medications to residents, including those with complex care needs such as cognitive impairment and swallowing difficulties. METHOD A time-and-motion study was conducted in three South Australian RACFs. A representative sample of 57 scheduled medication administration rounds in 14 units were observed by a single investigator. The rounds were sampled to include different times of day, memory support units for residents living with dementia and standard units, and medication administration by registered and enrolled nurses. Medications were administered from pre-prepared medication strip packaging. The validated Work Observation Method By Activity Timing (WOMBAT) software was used to record observations. RESULTS Thirty nurses were observed. The average time spent on scheduled medication administration rounds was 5.2 h/unit of average 22 residents/day. The breakfast medication round had the longest duration (1.92 h/unit). Resident preparation, medication preparation and provision, documentation, transit, communication, and cleaning took an average of 5 minutes per resident per round. Medication preparation and provision comprised 60% of overall medication round time and took significantly longer in memory support than in standard units (66 vs 49 seconds per resident per round for preparation, 79 vs 58 for provision; P < .001 for both). Almost half (42%) of tablets/capsules were crushed in memory support units. The time taken for medication administration was not significantly different among registered and enrolled nurses. CONCLUSIONS Nurses took an average of 5 minutes to administer medications per resident per medication round. Medication administration in memory support units took an additional minute per resident per round, with almost half of tablets and capsules needing to be crushed.
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Affiliation(s)
- Esa Y H Chen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Melbourne, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Melbourne, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Megan Corlis
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, Australia.,Helping Hand Aged Care, North Adelaide, Australia
| | | | | | - Jan Van Emden
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, Australia.,Helping Hand Aged Care, North Adelaide, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Sarah N Hilmer
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, Australia.,Kolling Institute, Faculty of Medicine and Health, The University of Sydney and Royal North Shore Hospital, St Leonards, Australia
| | - Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Melbourne, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, Australia
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9
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Drumond N, Stegemann S. Better Medicines for Older Patients: Considerations between Patient Characteristics and Solid Oral Dosage Form Designs to Improve Swallowing Experience. Pharmaceutics 2020; 13:pharmaceutics13010032. [PMID: 33379258 PMCID: PMC7824227 DOI: 10.3390/pharmaceutics13010032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 02/07/2023] Open
Abstract
Oral drug administration provided as solid oral dosage forms (SODF) remains the major route of drug therapy in primary and secondary care. There is clear evidence for a growing number of clinically relevant swallowing issues (e.g., dysphagia) in the older patient population, especially when considering the multimorbid, frail, and polymedicated patients. Swallowing impairments have a negative impact on SODF administration, which leads to poor adherence and inappropriate alterations (e.g., crushing, splitting). Different strategies have been proposed over the years in order to enhance the swallowing experience with SODF, by using conventional administration techniques or applying swallowing aids and devices. Nevertheless, new formulation designs must be considered by implementing a patient centric approach in order to efficiently improve SODF administration by older patient populations. Together with appropriate SODF size reductions, innovative film coating materials that can be applied to SODF and provide swallowing safety and efficacy with little effort being required by the patients are still needed. With that in mind, a literature review was conducted in order to identify the availability of patient centric coating materials claiming to shorten esophageal transit times and improve the overall SODF swallowing experience for older patients. The majority of coating technologies were identified in patent applications, and they mainly included well-known water soluble polymers that are commonly applied into pharmaceutical coatings. Nevertheless, scientific evidence demonstrating the benefits of given SODF coating materials in the concerned patient populations are still very limited. Consequently, the availability for safe, effective, and clinically proven solutions to address the increasing prevalence of swallowing issues in the older patient population is still limited.
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Affiliation(s)
- Nélio Drumond
- Correspondence: (N.D.); (S.S.); Tel.: +49-178-2144689 (N.D.); +49-172-6054869 (S.S.)
| | - Sven Stegemann
- Correspondence: (N.D.); (S.S.); Tel.: +49-178-2144689 (N.D.); +49-172-6054869 (S.S.)
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10
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Martir J, Flanagan T, Mann J, Fotaki N. Impact of Food and Drink Administration Vehicles on Paediatric Formulation Performance Part 2: Dissolution of Montelukast Sodium and Mesalazine Formulations. AAPS PharmSciTech 2020; 21:287. [PMID: 33063245 PMCID: PMC7561592 DOI: 10.1208/s12249-020-01815-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/08/2020] [Indexed: 11/30/2022] Open
Abstract
Paediatric medicines are not always age-appropriate, causing problems with dosing, acceptability and adherence. The use of food and drinks as vehicles for medicine co-administration is common practice, yet the impact on drug bioavailability, safety and efficacy remains unaddressed. The aim of this study was to use in vitro dissolution testing, under infant simulating conditions, to evaluate the effect of co-administration with vehicles on the dissolution performance of two poorly soluble paediatric drugs. Dissolution studies of mesalazine and montelukast formulations were conducted with mini-paddle apparatus on a two-stage approach: simulated gastric fluid followed by addition of simulated intestinal fluid. The testing scenarios were designed to reflect daily administration practices: direct administration of formulation; formulation co-administered with food and drinks, both immediately after mixing and 4 h after mixing. Drug dissolution was significantly affected by medicine co-administration with vehicles, compared to the direct administration of formulation. Furthermore, differences were observed on drug dissolution when the formulations were mixed with different vehicles of the same subtype. The time between preparation and testing of the drug-vehicle mixture also impacted dissolution behaviour. Drug dissolution was shown to be significantly affected by the physicochemical properties and composition of the vehicles, drug solubility in each vehicle and drug/formulation characteristics. Ultimately, in this study, we show the potential of age-appropriate in vitro dissolution testing as a useful biopharmaceutical tool for estimating drug dissolution in conditions relevant to the paediatric population. The setup developed has potential to evaluate the impact of medicine co-administration with vehicles on paediatric formulation performance.
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11
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Sefidani Forough A, Lau ETL, Steadman KJ, Kyle GJ, Cichero JAY, Serrano Santos JM, Nissen LM. Factors that affect health-care workers' practices of medication administration to aged care residents with swallowing difficulties: An Australia-wide survey study. Australas J Ageing 2020; 40:e79-e86. [PMID: 32985061 DOI: 10.1111/ajag.12856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/15/2020] [Accepted: 08/16/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To understand the barriers and facilitators of medication administration to aged care residents with swallowing difficulties. METHODS Health-care workers in aged care facilities across Australia involved in medication administration to residents completed an online survey. RESULTS Of 355 respondents, 90.9% reported 'everyday' encounters with residents with swallowing difficulties and 94.1% modified medications to facilitate administration. Time constraints (63.4%) and workload (69.0%) were common barriers. Only 39.0% believed swallowing abilities are considered at the prescribing stage. Pill size (95.8%), polypharmacy (75.2%) and lack of alternative formulations (74.9%) contributed to these challenges. Support from other health-care professionals (91.5%) and training (85.9%) were the most favoured facilitators. CONCLUSION Health-care workers are faced with various challenges when caring for residents with swallowing difficulties. Promoting multidisciplinary collaborations, provision of training and medication review services, and improving skill mix and staffing composition in aged care facilities are needed to address these challenges.
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Affiliation(s)
- Aida Sefidani Forough
- Discipline of Pharmacy, Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Qld, Australia
| | - Esther T L Lau
- Discipline of Pharmacy, Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Qld, Australia.,School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
| | - Kathryn J Steadman
- Discipline of Pharmacy, Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Qld, Australia.,School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
| | - Greg J Kyle
- Discipline of Pharmacy, Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Qld, Australia
| | - Julie A Y Cichero
- Discipline of Pharmacy, Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Qld, Australia.,School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
| | - Jose Manuel Serrano Santos
- Discipline of Pharmacy, Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Qld, Australia
| | - Lisa M Nissen
- Discipline of Pharmacy, Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Qld, Australia.,School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
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12
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Easy to Swallow “Instant” Jelly Formulations for Sustained Release Gliclazide Delivery. J Pharm Sci 2020; 109:2474-2484. [DOI: 10.1016/j.xphs.2020.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 11/19/2022]
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13
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Appropriateness of oral dosage form modification for aged care residents: a video-recorded observational study. Int J Clin Pharm 2020; 42:938-947. [DOI: 10.1007/s11096-020-01036-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 04/11/2020] [Indexed: 12/17/2022]
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Silva MRMD, Dysars LP, Santos EPD, Ricci Júnior E. Preparation of extemporaneous oral liquid in the hospital pharmacy. BRAZ J PHARM SCI 2020. [DOI: 10.1590/s2175-97902019000418358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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15
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Forough AS, Wong SYM, Lau ETL, Santos JMS, Kyle GJ, Steadman KJ, Cichero JAY, Nissen LM. Nurse experiences of medication administration to people with swallowing difficulties living in aged care facilities: a systematic review of qualitative evidence. ACTA ACUST UNITED AC 2019; 16:71-86. [PMID: 29324559 DOI: 10.11124/jbisrir-2016-003334] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To identify nurses' experiences of administering oral medications to residents of aged care facilities (ACFs) with swallowing difficulties. INTRODUCTION Administering medicines to older people with swallowing difficulties is a challenging task. Nurses frequently modify oral medications e.g. by crushing/splitting tablets or opening capsules, to facilitate the administration process. These practices are associated with an increased risk of medication administration errors. However, the reasons for these practices from the nurse's perspective are not well understood. INCLUSION CRITERIA The review investigated studies on the experiences of nurses of any level with the responsibility of medication administration in ACFs in terms of problems and challenges they encountered when administering oral medicines to aged care residents with swallowing difficulties. Aged care facilities providing all levels of care were considered for inclusion. Qualitative studies including, but not limited to, phenomenology, grounded theory, ethnography and action research designs as well as mixed methods studies and text and opinion papers were considered. METHODS A comprehensive database search of PubMed, CINAHL, Embase and Scopus was conducted between October and December 2016. MedNar and ProQuest Dissertations and Theses were used to search for gray literature. No date limitation was applied. The Joanna Briggs Institute Qualitative Assessment and Review Instrument critical appraisal tool (JBI-QARI) was used to assess the quality of the papers. The JBI-QARI data extraction instrument was used to extract qualitative findings. Data synthesis was not applicable in the final analysis due to the inclusion of only one article. RESULTS The initial search resulted in 1681 unique titles for screening. A total of 202 abstracts were screened, after which a full-text review conducted for 19 articles. After the full-text review, only one article was eligible to be included in the final report. The included study scored highly in terms of methodological quality. The findings highlighted issues around time constraints, complexity of medication administration process to residents of ACFs with swallowing difficulties, cost and resources for alternative strategies, inefficient information flow and communication among healthcare professionals, and nurses' knowledge and training needs. CONCLUSION The limited findings of this systematic review indicate that further research is necessary to provide evidence of nurses' experiences with regards to administering oral medications to older people with swallowing difficulties living in ACFs. A comprehensive understanding of these experiences may lead to organizational system changes to support nurses and older people with swallowing difficulties in ACFs.
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Affiliation(s)
- Aida Sefidani Forough
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Simon Y M Wong
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Esther T L Lau
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia.,CEBHA (Centre for Evidence-Based Healthy Ageing): a Joanna Briggs Institute Centre of Excellence, Brisbane, Australia
| | - Jose Manuel Serrano Santos
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia.,CEBHA (Centre for Evidence-Based Healthy Ageing): a Joanna Briggs Institute Centre of Excellence, Brisbane, Australia
| | - Greg J Kyle
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Kathryn J Steadman
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia.,School of Pharmacy, University of Queensland, Brisbane, Australia
| | - Julie A Y Cichero
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia.,School of Pharmacy, University of Queensland, Brisbane, Australia
| | - Lisa M Nissen
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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McDerby N, Kosari S, Bail K, Shield A, Peterson G, Naunton M. The effect of a residential care pharmacist on medication administration practices in aged care: A controlled trial. J Clin Pharm Ther 2019; 44:595-602. [DOI: 10.1111/jcpt.12822] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/09/2019] [Accepted: 01/18/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Nicole McDerby
- Discipline of Pharmacy; Faculty of Health; University of Canberra; Bruce Australian Capital Territory Australia
| | - Sam Kosari
- Discipline of Pharmacy; Faculty of Health; University of Canberra; Bruce Australian Capital Territory Australia
| | - Kasia Bail
- Discipline of Nursing; Faculty of Health; University of Canberra; Bruce Australian Capital Territory Australia
| | - Alison Shield
- Discipline of Pharmacy; Faculty of Health; University of Canberra; Bruce Australian Capital Territory Australia
| | - Gregory Peterson
- Discipline of Pharmacy; Faculty of Health; University of Canberra; Bruce Australian Capital Territory Australia
- School of Pharmacy; University of Tasmania; Hobart Tasmania Australia
| | - Mark Naunton
- Discipline of Pharmacy; Faculty of Health; University of Canberra; Bruce Australian Capital Territory Australia
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Mc Gillicuddy A, Kelly M, Crean AM, Sahm LJ. Understanding the knowledge, attitudes and beliefs of community-dwelling older adults and their carers about the modification of oral medicines: A qualitative interview study to inform healthcare professional practice. Res Social Adm Pharm 2019; 15:1425-1435. [PMID: 30658913 DOI: 10.1016/j.sapharm.2019.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/24/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Oral medicines are commonly modified (e.g. tablets split/crushed) to meet the dosing and swallowing requirements of older adults. However, there is limited research investigating the opinions of community-dwelling patients and carers about medicine modification. OBJECTIVES The aim of this study was to investigate the views of community-dwelling older adults and their carers about oral medicine modification. METHODS Semi-structured, face-to-face interviews were conducted with community-dwelling older adults and carers of older adults who experienced difficulty swallowing medicines, or who required medicines to be modified. Participants were recruited from purposively selected community pharmacies using a combination of purposive, convenience and snowball sampling. Interviews were audio-recorded, transcribed verbatim and analysed thematically. The Francis method governed when data saturation had been reached. RESULTS Twenty-six interviews (13 patients, 13 carers) were conducted (76.9% female, median length 11 min (IQR 8-16 min)). Four themes emerged from the data: variation in medical needs and preferences; balancing acceptance and resignation; healthcare professional engagement and; opportunities for optimising formulation suitability. The heterogeneity of medical conditions experienced by community-dwelling older adults resulted in a variety of modifications being required. Patients and carers are accepting of their medications and formulations. However, when challenges arise, they tend to feel resigned to coping within the constraints of the current medication regimen, resulting in a lack of focused communication with healthcare professionals. Thus, healthcare professionals were unaware of their difficulties and unable to offer advice or solutions. CONCLUSION Healthcare professionals must engage proactively with this group. Whilst a holistic approach to medication management is ideal, the disadvantage is that no single healthcare professional may identify this as their responsibility. Whilst the input and expertise of all healthcare professionals will be required, as medication experts, the pharmacy profession should take ownership and become the champion of, and for, the patient.
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Affiliation(s)
- Aoife Mc Gillicuddy
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork (UCC), Cork, Ireland.
| | - Maria Kelly
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork (UCC), Cork, Ireland.
| | - Abina M Crean
- School of Pharmacy, University College Cork (UCC), Cork, Ireland.
| | - Laura J Sahm
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork (UCC), Cork, Ireland; Pharmacy Department, Mercy University Hospital, Cork, Ireland.
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18
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Antimisiaris D, Cutler T. Managing Polypharmacy in the 15-Minute Office Visit. PHYSICIAN ASSISTANT CLINICS 2018. [DOI: 10.1016/j.cpha.2018.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Khan MS, Roberts MS. Challenges and innovations of drug delivery in older age. Adv Drug Deliv Rev 2018; 135:3-38. [PMID: 30217519 DOI: 10.1016/j.addr.2018.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/31/2018] [Accepted: 09/07/2018] [Indexed: 12/12/2022]
Abstract
Both drug delivery performance and various age-related physical, mental and physiological changes can affect drug effectiveness and safety in elderly patients. The many drug delivery systems developed over the years include recent novel transdermal, nasal, pulmonary and orally disintegrating tablets that provide consistent, precise, timely and more targeted drug delivery. Certain drug delivery systems may be associated with suboptimal outcomes in the elderly because of the nature of drug present, a lack of appreciation of the impact of age-related changes in drug absorption, distribution and clearance, the limited availability of pharmacokinetic, safety and clinical data. Polypharmacy, patient morbidity and poor adherence can also contribute to sub-optimal drug delivery systems outcomes in the elderly. The development of drug delivery systems for the elderly is a poorly realised opportunity, with each system having specific advantages and limitations. A key challenge is to provide the innovation that best meets the specific physiological, psychological and multiple drug requirements of individual elderly patients.
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20
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Lau ETL, Steadman KJ, Cichero JAY, Nissen LM. Dosage form modification and oral drug delivery in older people. Adv Drug Deliv Rev 2018; 135:75-84. [PMID: 29660383 DOI: 10.1016/j.addr.2018.04.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 02/15/2018] [Accepted: 04/12/2018] [Indexed: 11/29/2022]
Abstract
Many people cannot swallow whole tablets and capsules. The cause ranges from difficulties overriding the natural instinct to chew solids/foodstuff before swallowing, to a complex disorder of swallowing function affecting the ability to manage all food and fluid intake. Older people can experience swallowing difficulties because of co-morbidities, age-related physiological changes, and polypharmacy. To make medicines easier to swallow, many people will modify the medication dosage form e.g. split or crush tablets, and open capsules. Some of the challenges associated with administering medicines to older people, and issues with dosage form modification will be reviewed. Novel dosage forms in development are promising and may help overcome some of the issues. However, until these are more readily available, effective interdisciplinary teams, and improving patient health literacy will help reduce the risk of medication misadventures in older people.
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Affiliation(s)
- Esther T L Lau
- School of Clinical Sciences, QUT (Queensland University of Technology), Gardens Point Campus, 2 George St, Brisbane, QLD 4000, Australia.
| | - Kathryn J Steadman
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4102, Australia.
| | - Julie A Y Cichero
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4102, Australia.
| | - Lisa M Nissen
- School of Clinical Sciences, QUT (Queensland University of Technology), Gardens Point Campus, 2 George St, Brisbane, QLD 4000, Australia.
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Oberoi RK, Zhao W, Sidhu DS, Viani RM, Trinh R, Liu W. A Phase 1 Study to Evaluate the Effect of Crushing, Cutting Into Half, or Grinding of Glecaprevir/Pibrentasvir Tablets on Exposures in Healthy Subjects. J Pharm Sci 2018; 107:1724-1730. [DOI: 10.1016/j.xphs.2018.02.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 10/18/2022]
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Abstract
Polypharmacy is an underappreciated factor in undesirable patient outcomes. In older adults, polypharmacy is considered a syndrome of harm and presents a challenge to primary care providers. The United States has one of the highest medication use rates per capita in the world. With the aging population, and polypharmacy a significant part of the lives of older adults, management of polypharmacy poses both a growing challenge and an opportunity for all health care providers. This article provides an overview of skills to improve medication use management in older adults living with polypharmacy.
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Affiliation(s)
- Demetra Antimisiaris
- Pharmacy and Medication Management Program, Department of Pharmacology and Toxicology, University of Louisville, 501 East Broadway, Suite 240, Louisville, KY 40202, USA; Department of Neurology, University of Louisville, 501 East Broadway, Suite 240, Louisville, KY 40202, USA; Department of Family Medicine and Geriatrics, University of Louisville, 501 East Broadway, Suite 240, Louisville, KY 40202, USA.
| | - Timothy Cutler
- Department of Clinical Pharmacy, UCSF School of Pharmacy, 533 Parnassus Avenue U585, UCSF POBox 0622, San Francisco, CA 94117, USA
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23
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Polymer adhesion predictions for oral dosage forms to enhance drug administration safety. Part 1: In vitro approach using particle interaction methods. Colloids Surf B Biointerfaces 2018; 165:9-17. [DOI: 10.1016/j.colsurfb.2018.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/30/2018] [Accepted: 02/06/2018] [Indexed: 11/21/2022]
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Masilamoney M, Dowse R. Knowledge and practice of healthcare professionals relating to oral medicine use in swallowing-impaired patients: a scoping review. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2018; 26:199-209. [DOI: 10.1111/ijpp.12447] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 02/28/2018] [Indexed: 12/01/2022]
Abstract
Abstract
Objectives
Swallowing impairment is a growing problem that affects 16% of the overall population and can significantly affect medicine-taking. However, little is known about the knowledge and practice of healthcare professionals (HCPs) relating to swallowing-impaired (SI) patients. The aim of this scoping review was to investigate the knowledge and practice of HCPs in supporting SI patients with their medicine-taking, to identify their reference sources, and to describe their training and information needs.
Method
Databases searched included Scopus, Web of Science, Medline and Google Scholar from inception to August 2017. Qualitative and quantitative studies describing knowledge and practice of HCPs relating to medicine use in SI patients were included.
Key findings
The nine included studies, from an initial 142, involved nurses (nine studies), pharmacists (one study) and doctors (two studies) in hospitals or aged-care facilities. A knowledge deficit linked to lack of training was revealed, particularly with identification of modified-release dosage forms, medication that can/cannot be crushed, vehicle for safe dispersion, consequences of inappropriate modification, drug stability and legal aspects. Written information sources were named, but not used in practice. Pharmacists were the primary experts for consultation, and were involved in nurse education, and were members of multidisciplinary teams.
Conclusions
Knowledge in nurses was inadequate, with practice indicating potentially serious medication-related errors. Additional training, either undergraduate or as continuing professional development, is recommended. Information to guide safe medicine modification practice should be accessible to all practitioners. Pharmacists could take the lead role in offering training to nurses.
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Affiliation(s)
| | - Ros Dowse
- Faculty of Pharmacy, Rhodes University, Grahamstown, South Africa
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25
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Thong MY, Manrique YJ, Steadman KJ. Drug loss while crushing tablets: Comparison of 24 tablet crushing devices. PLoS One 2018; 13:e0193683. [PMID: 29494695 PMCID: PMC5832315 DOI: 10.1371/journal.pone.0193683] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 02/15/2018] [Indexed: 11/18/2022] Open
Abstract
This study investigated 24 tablet crushing devices for drug loss using different methods to recover the crushed tablet. 24 devices were compared: 3 with disposable cups, 6 with disposable bags, 12 without separate vessels and 3 types of mortar and pestle. One paracetamol tablet was crushed and recovered by tapping the powder out. Where appropriate, depending on crusher size and manufacturer instructions, the powder was also recovered by mixing with water or food. Paracetamol recovery (quantity that can be delivered to a patient) and leftover (quantity remaining in the device) were measured using a validated UV method and the entire experiment was replicated 3 times. Drug recovery ranged from 86.7-98.1% when the crushed tablet was tapped out of the crushers (average loss 5.8%). Significant losses were measured for 18 crushers, particularly manually operated hand-twist crushers with a serrated crushing surface, and some devices with disposable bags or cups. Rinsing the crushed powder with water once resulted in an average of 24.2% drug loss, and this was reduced to 4.2% after a second rinse. If crushing is unavoidable, maximizing medication delivery to the patient is essential. Rinsing twice resulted in similar paracetamol recovery to tapping the powder out; however only water rinses have the potential for direct consumption by the patient, minimizing drug loss across the entire crushing and transfer process.
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Affiliation(s)
- Min Yew Thong
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Yady J. Manrique
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Kathryn J. Steadman
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
- * E-mail:
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26
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Qian S, Yu P, Hailey D. Nursing staff work patterns in a residential aged care home: a time-motion study. AUST HEALTH REV 2018; 40:544-554. [PMID: 26615222 DOI: 10.1071/ah15126] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/16/2015] [Indexed: 11/23/2022]
Abstract
Objective Residential aged care services are challenged by an increasing number of residents and a shortage of nursing staff. Developing strategies to overcome this challenge requires an understanding of nursing staff work patterns. The aim of the present study was to investigate the work processes followed by nursing staff and how nursing time is allocated in a residential aged care home. Methods An observational time-motion study was conducted at two aged care units for 12 morning shifts. Seven nurses were observed, one per shift. Results In all, there were 91h of observation. The results showed that there was a common work process followed by all nurse participants. Medication administration, documentation and verbal communication were the most time-consuming activities and were conducted most frequently. No significant difference between the two units was found in any category of activities. The average duration of most activities was less than 1min. There was no difference in time utilisation between the endorsed enrolled nurses and the personal carers in providing nursing care. Conclusion Medication administration, documentation and verbal communication were the major tasks in morning shifts in a residential aged care home. Future research can investigate how verbal communication supports nursing care. What is known about the topic? The aging population will substantially increase the demand for residential aged care services. There is a lack of research on nurses' work patterns in residential aged care homes. What does this paper add? The present study provides a comprehensive understanding of nurses' work patterns in a residential aged care home. There is a common work process followed by nurses in providing nursing care. Medication administration, verbal communication and documentation are the most time-consuming activities and they are frequently conducted in the same period of time. Wound care, physical review and documentation on desktop computers are arranged flexibly by the nurses. What are the implications for practitioners? When developing a task reallocation strategy to improve work efficiency, effort can be put into tasks that can be arranged more flexibly.
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Affiliation(s)
- Siyu Qian
- School of Computing and Information Technology, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
| | - Ping Yu
- School of Computing and Information Technology, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
| | - David Hailey
- School of Computing and Information Technology, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
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Gilmartin-Thomas JFM, Smith F, Wolfe R, Jani Y. A comparison of medication administration errors from original medication packaging and multi-compartment compliance aids in care homes: A prospective observational study. Int J Nurs Stud 2017; 72:15-23. [PMID: 28433827 DOI: 10.1016/j.ijnurstu.2017.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/09/2017] [Accepted: 03/25/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND No published study has been specifically designed to compare medication administration errors between original medication packaging and multi-compartment compliance aids in care homes, using direct observation. OBJECTIVES Compare the effect of original medication packaging and multi-compartment compliance aids on medication administration accuracy. DESIGN Prospective observational. SETTING Ten Greater London care homes. PARTICIPANTS Nurses and carers administering medications. METHODS Between October 2014 and June 2015, a pharmacist researcher directly observed solid, orally administered medications in tablet or capsule form at ten purposively sampled care homes (five only used original medication packaging and five used both multi-compartment compliance aids and original medication packaging). The medication administration error rate was calculated as the number of observed doses administered (or omitted) in error according to medication administration records, compared to the opportunities for error (total number of observed doses plus omitted doses). RESULTS Over 108.4h, 41 different staff (35 nurses, 6 carers) were observed to administer medications to 823 residents during 90 medication administration rounds. A total of 2452 medication doses were observed (1385 from original medication packaging, 1067 from multi-compartment compliance aids). One hundred and seventy eight medication administration errors were identified from 2493 opportunities for error (7.1% overall medication administration error rate). A greater medication administration error rate was seen for original medication packaging than multi-compartment compliance aids (9.3% and 3.1% respectively, risk ratio (RR)=3.9, 95% confidence interval (CI) 2.4 to 6.1, p<0.001). Similar differences existed when comparing medication administration error rates between original medication packaging (from original medication packaging-only care homes) and multi-compartment compliance aids (RR=2.3, 95%CI 1.1 to 4.9, p=0.03), and between original medication packaging and multi-compartment compliance aids within care homes that used a combination of both medication administration systems (RR=4.3, 95%CI 2.7 to 6.8, p<0.001). A significant difference in error rate was not observed between use of a single or combination medication administration system (p=0.44). CONCLUSION The significant difference in, and high overall, medication administration error rate between original medication packaging and multi-compartment compliance aids supports the use of the latter in care homes, as well as local investigation of tablet and capsule impact on medication administration errors and staff training to prevent errors occurring. As a significant difference in error rate was not observed between use of a single or combination medication administration system, common practice of using both multi-compartment compliance aids (for most medications) and original packaging (for medications with stability issues) is supported.
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Affiliation(s)
- Julia Fiona-Maree Gilmartin-Thomas
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom.
| | - Felicity Smith
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yogini Jani
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom; Pharmacy Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Richey RH, Hughes C, Craig JV, Shah UU, Ford JL, Barker CE, Peak M, Nunn AJ, Turner MA. A systematic review of the use of dosage form manipulation to obtain required doses to inform use of manipulation in paediatric practice. Int J Pharm 2017; 518:155-166. [DOI: 10.1016/j.ijpharm.2016.12.032] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/12/2016] [Accepted: 12/13/2016] [Indexed: 01/09/2023]
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Fodil M, Nghiem D, Colas M, Bourry S, Poisson-Salomon AS, Rezigue H, Trivalle C. Assessment of Clinical Practices for Crushing Medication in Geriatric Units. J Nutr Health Aging 2017; 21:904-908. [PMID: 28972243 DOI: 10.1007/s12603-017-0886-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the modification of the form of medication and evaluate staff observance of good clinical practices. DESIGN One-day assessment of clinical practices. SETTING 17 geriatrics units in the 3 Teaching Hospitals of Paris-Sud (APHP), France. PARTICIPANTS Elderly in-patients with difficulties swallowing capsules and tablets. MEASUREMENTS Assessment of target-patient prescriptions and direct observation of nurses' medical rounds. RESULTS 155/526 in-patients (29.5%) were unable to swallow tablets or capsules: 98 (40.3%) in long-term care, 46 patients (23.8%) in the rehabilitation unit and 11 (12.2%) in the acute care unit (p = .005). In thirty-nine (27.3%) of the 143 prescriptions studied all tablets were safe to crush and all capsules were safe to open. In 104 cases, at least one medication could not be safely modified, including 26 cases (18.2%) in which none of the prescribed drugs were safe to crush or open. In 48.2% of the 110 medications that were crushed, crushing was forbidden, and presented a potential threat in 12.7% of cases or a reduced efficacy in 8.2% of cases. Crushing methods were rarely appropriate: no specific protective equipment was used (81.8%), crushing equipment was shared between patients without cleaning (95.1%), medications were spilled or lost (69.9%). The method of administration was appropriate (water, jellified water) in 25% of the cases, questionable (soup, coffee, compote, juice, cream) in 55% of the cases and unacceptable (laxative) in 21% of the cases. CONCLUSION Management of drug prescriptions in patients with swallowing difficulties is not optimal, and may even have iatrogenic effects. In this study, 12.7% of the modifications of the drug form could have been harmful. Doctors, pharmacists and nurses need to reevaluate their practices.
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Affiliation(s)
- M Fodil
- Christophe Trivalle, Service de Gérontologie 1, Hôpital Paul Brousse, 14 avenue Paul Vaillant-Couturier, F-94800, Villejuif, France. E-mail:
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Martir J, Flanagan T, Mann J, Fotaki N. Recommended strategies for the oral administration of paediatric medicines with food and drinks in the context of their biopharmaceutical properties: a review. ACTA ACUST UNITED AC 2016; 69:384-397. [PMID: 27704550 DOI: 10.1111/jphp.12635] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/10/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVES This review focuses on the recommended strategies for the oral administration of paediatric medicines with food in the context of their biopharmaceutical properties. KEY FINDINGS Acceptability of oral medicines in young patients is more challenging than in adult patients. Mixing oral dosage forms with foods and drinks is sometimes suggested to administer a specific dose and enhance compliance in the paediatric population. In this review, the strategies for the co-administration of paediatric medicines with food and drinks are discussed. Current administration practices as reported by healthcare professionals and parents/carers are compared with the relevant guidelines. Differences in the type of vehicles recommended to be used and actually used in current practice were identified. Correlations of the type of food recommended, the type of formulation and the drug's biopharmaceutical classification system (BCS) class were performed and revealed that recommendations should be made on a case-by-case basis. SUMMARY The propensity for physiochemical or bioavailability changes that may occur from the co-administration of medicines with food and drinks in the paediatric population should be considered, and harmonisation of the recommended administration strategies is needed.
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Affiliation(s)
- Joana Martir
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Talia Flanagan
- Pharmaceutical Technology and Development, Astra Zeneca, Macclesfield, UK
| | - James Mann
- Pharmaceutical Technology and Development, Astra Zeneca, Macclesfield, UK
| | - Nikoletta Fotaki
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
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Stegemann S. Towards better understanding of patient centric drug product development in an increasingly older patient population. Int J Pharm 2016; 512:334-342. [DOI: 10.1016/j.ijpharm.2016.01.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 01/19/2016] [Indexed: 01/08/2023]
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The knowledge, attitudes and beliefs of patients and their healthcare professionals around oral dosage form modification: A systematic review of the qualitative literature. Res Social Adm Pharm 2016; 13:717-726. [PMID: 27729203 DOI: 10.1016/j.sapharm.2016.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 09/20/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The objective of this systematic review was to synthesize the available qualitative evidence on the knowledge, attitudes and beliefs of adult patients, healthcare professionals and carers about oral dosage form modification. DESIGN A systematic review and synthesis of qualitative studies was undertaken, utilising the thematic synthesis approach. DATA SOURCES The following databases were searched from inception to September 2015: PubMed, Medline (EBSCO), EMBASE, CINAHL, PsycINFO, Web of Science, ProQuest Databases, Scopus, Turning Research Into Practice (TRIP), Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews (CDSR). Citation tracking and searching the references lists of included studies was also undertaken. Grey literature was searched using the OpenGrey database, internet searching and personal knowledge. An updated search was undertaken in June 2016. REVIEW METHODS Studies meeting the following criteria were eligible for inclusion; (i) used qualitative data collection and analysis methods; (ii) full-text was available in English; (iii) included adult patients who require oral dosage forms to be modified to meet their needs or; (iv) carers or healthcare professionals of patients who require oral dosage forms to be modified. Two reviewers independently appraised the quality of the included studies using the Critical Appraisal Skills Programme Checklist. A thematic synthesis was conducted and analytical themes were generated. RESULTS Of 5455 records screened, seven studies were eligible for inclusion; three involved healthcare professionals and the remaining four studies involved patients. Four analytical themes emerged from the thematic synthesis: (i) patient-centred individuality and variability; (ii) communication; (iii) knowledge and uncertainty and; (iv) complexity. The variability of individual patient's requirements, poor communication practices and lack of knowledge about oral dosage form modification, when combined with the complex and multi-faceted healthcare environment complicate decision making regarding oral dosage form modification and administration. CONCLUSIONS This systematic review has highlighted the key factors influencing the knowledge, attitudes and beliefs of patients and healthcare professionals about oral dosage form modifications. The findings suggest that in order to optimise oral medicine modification practices the needs of individual patients should be routinely and systematically assessed and decision-making should be supported by evidence based recommendations with multidisciplinary input. Further research is needed to optimise oral dosage form modification practices and the factors identified in this review should be considered in the development of future interventions.
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Mc Gillicuddy A, Kelly M, Sweeney C, Carmichael A, Crean AM, Sahm LJ. Modification of oral dosage forms for the older adult: An Irish prevalence study. Int J Pharm 2016; 510:386-93. [DOI: 10.1016/j.ijpharm.2016.06.056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/09/2016] [Accepted: 06/22/2016] [Indexed: 12/11/2022]
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Older adults with difficulty swallowing oral medicines: a systematic review of the literature. Eur J Clin Pharmacol 2015; 72:141-51. [DOI: 10.1007/s00228-015-1979-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/08/2015] [Indexed: 10/22/2022]
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Patient-centred pharmaceutical design to improve acceptability of medicines: similarities and differences in paediatric and geriatric populations. Drugs 2015; 74:1871-1889. [PMID: 25274536 PMCID: PMC4210646 DOI: 10.1007/s40265-014-0297-2] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient acceptability of a medicinal product is a key aspect in the development and prescribing of medicines. Children and older adults differ in many aspects from the other age subsets of population and require particular considerations in medication acceptability. This review highlights the similarities and differences in these two age groups in relation to factors affecting acceptability of medicines. New and conventional formulations of medicines are considered regarding their appropriateness for use in children and older people. Aspects of a formulation that impact acceptability in these patient groups are discussed, including, for example, taste/smell/viscosity of a liquid and size/shape of a tablet. A better understanding of the acceptability of existing formulations highlights opportunities for the development of new and more acceptable medicines and facilitates safe and effective prescribing for the young and older populations.
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Affiliation(s)
- Alison Haywood
- School of Pharmacy; Griffith University, Gold Coast Campus
| | - Beverley Glass
- School of Pharmacy and Molecular Sciences; James Cook University; Townsville Queensland
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Nissen LM, Haywood A, Steadman KJ. Solid Medication Dosage Form Modification at the Bedside and in the Pharmacy of Queensland Hospitals. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2009.tb00436.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Lisa M Nissen
- School of Pharmacy; The University of Queensland; Brisbane
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Stegemann S. Drug administration via enteral tubing: an unresolved but increasing challenge. Expert Opin Drug Deliv 2014; 12:159-61. [PMID: 25345599 DOI: 10.1517/17425247.2015.976200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The number of patients with serious impairments of the swallowing function will continue to increase in the coming decades. Problems related to enteral feeding and drug administration to patients with swallowing issues is a growing concern of physicians, compounding pharmacists and nurses. The lack of information on the impact of compounding by mixing with liquid or food and/or administering through enteral or intestinal feeding tubes on the drug product safety and efficacy is problematic. In addition, there is a lack of appropriate alternative dosage forms of drugs for these routes of administration. As patients with swallowing issues represent a significant and growing patient population that is vulnerable and in need of effective drug therapy, the issue needs urgent attention by all stakeholders involved in healthcare provision. Incremental improvements at the different stages in the process, from product development to the patients' well-being are required to assure safe and effective drug therapy to an important patient population.
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Affiliation(s)
- Sven Stegemann
- Graz University of Technology, Institute of Process and Particle Engineering , Inffeldgasse 13, Graz, 8010 , Austria
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Mafiana RN, Taqi A, Al-Zakwani I. Evaluation of nurses' knowledge of oral solid dosage forms that should not be crushed at a university hospital in Oman. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2013. [DOI: 10.1111/jphs.12046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Aqeela Taqi
- Department of Pharmacy; Sultan Qaboos University Hospital; Muscat Oman
| | - Ibrahim Al-Zakwani
- Department of Pharmacology and Clinical Pharmacy; College of Medicine; Sultan Qaboos University; Muscat Oman
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Akram G, Mullen AB. Mixing medication into foodstuffs: Identifying the issues for paediatric nurses. Int J Nurs Pract 2013; 21:125-31. [DOI: 10.1111/ijn.12222] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Gazala Akram
- Strathclyde Institute of Pharmacy and Biomedical Sciences; University of Strathclyde; Glasgow UK
| | - Alex B Mullen
- Strathclyde Institute of Pharmacy and Biomedical Sciences; University of Strathclyde; Glasgow UK
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41
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Gillespie RJ, Harrison L, Mullan J. Medication management concerns of ethnic minority family caregivers of people living with dementia. DEMENTIA 2013; 14:47-62. [DOI: 10.1177/1471301213488900] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This qualitative study explored the medication management experiences of Australian ethnic minority family caregivers of people living with dementia. From the perspective of this group of caregivers, medication management was a source of stress resulting from the progressive loss of ability of care recipients to manage their own medications; the complexity of the medication regime and the caregiver’s lack of trust of the care recipient to safely and effectively manage medications. Caregivers used various strategies to manage medications and avoid conflict with care recipients including being watchful and involving other family members in medication management tasks. Family caregivers indicated that a lack of information and access to support to inform their medication management role added to their stress, which was exacerbated in some cases by limited English proficiency. Supportive factors noted by caregivers included a well-established relationship with a community pharmacist, involvement of a geriatrician, family support and caregiver support group participation.
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42
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Mercovich N, Kyle GJ, Naunton M. Safe to crush? A pilot study into solid dosage form modification in aged care. Australas J Ageing 2013; 33:180-4. [DOI: 10.1111/ajag.12037] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Nicole Mercovich
- Discipline of Pharmacy; University of Canberra; Canberra Australian Capital Territory Australia
| | - Greg J Kyle
- Discipline of Pharmacy; University of Canberra; Canberra Australian Capital Territory Australia
| | - Mark Naunton
- Discipline of Pharmacy; University of Canberra; Canberra Australian Capital Territory Australia
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Abstract
The age appropriateness of a pharmaceutical product for older patient populations is most important in achieving ease of use, administration, and adherence as well as the therapeutic benefit of the drug. Drug development is a lengthy and risky investment accompanied by extensive regulatory requirements to meet all the safety, efficacy, and quality criteria of a pharmaceutical product. Older adults represent a very heterogeneous patient population with different needs compared to younger adults. Major areas that should be considered in the design of age-appropriate products (AAP) are age- and disease-related aspects such as (a) different dose strengths, (b) issues in handling, administering, and managing the drug product, (c) and complex medication regimens. The application of different technologies can meet these specific needs and should be considered at the very beginning of product development when setting the targeted quality product profile (TQPP) or later on during the product life-cycle management.
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Affiliation(s)
- S Stegemann
- Capsugel, Rijksweg 11, 2880, Bornem, Belgium.
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Schiele JT, Quinzler R, Klimm HD, Pruszydlo MG, Haefeli WE. Difficulties swallowing solid oral dosage forms in a general practice population: prevalence, causes, and relationship to dosage forms. Eur J Clin Pharmacol 2012; 69:937-48. [DOI: 10.1007/s00228-012-1417-0] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 09/19/2012] [Indexed: 11/28/2022]
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Swallowing dysfunction and dysphagia is an unrecognized challenge for oral drug therapy. Int J Pharm 2012; 430:197-206. [DOI: 10.1016/j.ijpharm.2012.04.022] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 03/30/2012] [Accepted: 04/02/2012] [Indexed: 01/03/2023]
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Lám J, Rózsa E, Kis Szölgyémi M, Belicza E. [Survey of drug dispensing errors in hospital wards]. Orv Hetil 2011; 152:1391-8. [PMID: 21846613 DOI: 10.1556/oh.2011.29198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED Medication errors occur very frequently. The limited knowledge of contributing factors and risks prevents the development and testing of successful preventive strategies. OBJECTIVE To investigate the differences between the ordered and dispensed drugs, and to identify the risks during medication. METHODS Prospective direct observation at two inpatient hospital wards. RESULTS The number of observed doses was 775 and the number of ordered doses was 806. It was found that from the total opportunities of 803 errors 114 errors occurred in dispensed drugs corresponding to an error rate of 14.1%. Among the different types of errors, the most important errors were: dispensing inappropriate doses (25.4%), unauthorized tablet halving or crushing (24.6%), omission errors (16.4%) and dispensing an active ingredient different from the ordered (14.2%). 87% of drug dispensing errors were considered as errors with minor consequences, while 13% of errors were potentially serious. CONCLUSIONS Direct observation of the drug dispensing procedure appears to be an appropriate method to observe errors in medication of hospital wards. The results of the study and the identified risks are worth to be reconsidered and prevention measures should be applied to everyday health care practice to improve patient safety.
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Affiliation(s)
- Judit Lám
- Semmelweis Egyetem, Egészségügyi Közszolgálati Kar Egészségügyi Menedzserképző Központ Budapest Kútvölgyi út 2. 1125.
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Kelly J, Wright D, Wood J. Medicine administration errors in patients with dysphagia in secondary care: a multi-centre observational study. J Adv Nurs 2011; 67:2615-27. [PMID: 21615463 DOI: 10.1111/j.1365-2648.2011.05700.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIM The aim of this study was to describe the interventions used by nurses when administering oral medicines to patients with and without dysphagia, to quantify the appropriateness of these interventions and the medicine administration error rate. BACKGROUND The administration of medicines to patients with dysphagia is complex and potentially more error prone because of the need to match the medication's formulation to the swallowing ability of the patient. METHOD Data was collected on the preparation and administration of oral medicines to patients with and without dysphagia, including those with enteral feeding tubes, using undisguised direct observation of 65 nurse-led medicine administration rounds on stroke and care-of-the-elderly wards at four acute general hospitals in East of England between 1 March and 30 June 2008. RESULTS Of the 2129 medicine administrations observed, 817 involved an error, and of these 313 involved patients with dysphagia. Excluding time errors, the normalized frequency of medicine administration errors for patients with dysphagia was 21.1% compared with 5.9% for patients without. Using a mixed effects model and excluding time errors, there is a higher risk of errors for patients with dysphagia (excluding patients with enteral tubes) compared with those without (P < 0.001) and a further increase in risk of error for patients with enteral tubes compared with dysphagic patients without tubes (P < 0.001). CONCLUSION The increased medicine administration error rate in patients with dysphagia requires healthcare professionals to take extra care when prescribing, dispensing and administering medicines to this group.
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48
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Lam MSH. Extemporaneous compounding of oral liquid dosage formulations and alternative drug delivery methods for anticancer drugs. Pharmacotherapy 2011; 31:164-92. [PMID: 21275495 DOI: 10.1592/phco.31.2.164] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Oncology pharmacists face a constant challenge with patients who cannot swallow oral anticancer drugs, making extemporaneous oral liquid preparation a requirement. Improper extemporaneous preparation of these agents, especially with the traditional chemotherapy with a narrow therapeutic index, may increase the risk of over- or underdosing. In community pharmacies, multiple barriers exist that prevent these pharmacies from preparing extemporaneous oral anticancer drug formulations for a patient's use at home. In a home setting, patients or caregivers without proper counseling and education on how to safely handle chemotherapy are at increased risk for exposure to these drugs. Based on a review of the literature, compounding recipes are available for 46% of oral anticancer agents. A paucity of data exists on dose uniformity, bioequivalence, and stability of extemporaneous oral liquid formulations of anticancer drugs. Pharmacists must have an understanding of the basic scientific principles that are an essential foundation for the proper preparation of extemporaneous oral anticancer liquid formulations. The collaborative effort of a multidisciplinary team can also help identify different barriers in the community setting, especially in areas where community pharmacies may lack resources for the extemporaneous compounding of oral chemotherapy, and to find ways to coordinate better pharmaceutical care. There are great opportunities for oncology pharmacists, as well as community pharmacists, as a resource for educating and monitoring patients receiving oral chemotherapy to ensure dosing accuracy, safe administration, and proper disposal of hazardous drugs. Development of national guidelines to promote standards of practice in the community and/or home setting is urgently needed to help improve the safety of dispensing and handling oral chemotherapeutic agents, including extemporaneously compounded oral liquid formulations of these drugs.
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Affiliation(s)
- Masha S H Lam
- Hematology Oncology Infusion Clinic, Kaiser Permanente Health Plan, Antioch, California, USA.
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49
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Haw C, Stubbs J. Covert administration of medication to older adults: a review of the literature and published studies. J Psychiatr Ment Health Nurs 2010; 17:761-8. [PMID: 21040220 DOI: 10.1111/j.1365-2850.2010.01613.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of the study was to review published studies of covert medicines administration in older people, as well as carrying out a broad review of the subject. A review of MEDLINE, EMBASE, PsycINFO, BNI and CINAHL was conducted in order to identify studies providing quantitative or qualitative data on covert administration in older adults. National guidance on covert medication and the ethics and legality of the practice were also reviewed. Data were extracted from eight studies and one inspection report. In addition, one qualitative study was identified. Nine studies included a questionnaire or interview with staff and only one involved non-professional carers. Seven studies were from the UK. Disguising medication in food or drink was reported in 43-71% of nursing homes. In total, 1.5-17% of institutional patients were receiving medication covertly. Despite legislation, incomplete documentation was common and nursing staff alone often made the decision to administer medication covertly. Covert administration appears to be common in older adults with dementia but despite legislation it often takes place without documentation and consultation of all relevant parties. Staff education and training and local audit are needed to improve standards and safeguard vulnerable patients in institutions.
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Affiliation(s)
- C Haw
- Consultant Psychiatrist, and Research Pharmacist, St Andrew's Healthcare, Northampton, UK.
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Administration of medicines in food and drink: a study of older inpatients with severe mental illness. Int Psychogeriatr 2010; 22:409-16. [PMID: 20078907 DOI: 10.1017/s1041610209991669] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Difficulties in administering medicines to older people are common, and medicines are sometimes mixed with food and drink to aid administration. Little is known about this practice or that of covert administration. This study aims to examine the nature, frequency, safety, reasons for and documentation of the administration of medicines in food and drink. METHODS A cross-sectional survey of mainly older adults, who were inpatients at a U.K. tertiary referral centre, was carried out, and nursing staff and consultant psychiatrists were interviewed. RESULTS Of the 110 patients, 34 (30.9%) were receiving medication mixed with food or drink, although for only 52.9% was the procedure documented in the patient's care plan and for 64.7% was it documented on the medication chart. No associated safety issues were identified. The main reasons for this practice were swallowing difficulties (61.8%) and refusal to swallow tablets (47.1%). Thirteen out of 110 (11.8%) patients were receiving covert medication, most commonly antipsychotics and anxiolytics or hypnotics. All were detained and lacked capacity to consent. Most had dementia but a few had chronic schizophrenia. For only 46.2% was covert administration documented in the care plan and for 69.2% on the medication chart. CONCLUSIONS Administration of medication in food or drink and covert medication were common in this group of hospitalized patients with severe mental illness. Before administering medication covertly it is important to discuss the matter with the multidisciplinary team and, where appropriate, with the patient's relatives. It is also important to ensure that supporting documentation has been completed in order to avoid medico-legal difficulties.
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