Nurses modify meds as ‘necessary evil’

A study of geriatric care nurses found that many still crush medications, split doses or otherwise modify orally administered medicines — a practice they see as helping patients with swallowing difficulties, dementia or other conditions.

Researchers in Ireland conducted private interviews with 18 nurses about medication practices, reporting in December’s BMJ Open that those working with patients 65 and over found pill modification a “necessary evil.”

Some nurses cited time as one reason they crushed pills into food; others complained that some hard-to-swallow pills weren’t supplied in liquid forms.

Researchers cited numerous lessons to be learned. Crushing tablets and opening capsules may alter the site or rate of drug absorption, which could lower drug level and efficacy or, alternatively, increase drug levels and associated toxicity.

Aoife McGillicuddy of the School of Pharmacy at the University College Cork National University said the unique needs of older adults should push healthcare professionals, policy makers and the pharmaceutical industry to develop more age-appropriate formulations, with better practical guidance.