Solid Medication Dosage Form Modification at the Bedside and in the Pharmacy of Queensland Hospitals

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Abstract

Background:

Solid medication dosage forms are regularly modified to aid medication delivery to patients that are unable to swallow them.

Aim:

To identify medications that are commonly modified in Queensland hospitals at the bedside and in the pharmacy and to identify how these modifications are made.

Method:

A self-report survey was sent to 97 hospitals of varying sizes in metropolitan and rural areas across Queensland.

Results:

Most (n = 31; 79%) of the responding hospitals reported that medications were modified at the bedside. 73 different medications were modified at the bedside. Most of the tablets or capsules had standard-release characteristics. 8 hospitals crushed modified-release dosage forms and 11 hospitals crushed medications with a narrow therapeutic index. At the bedside, 88% of medications were modified for adult use, mostly by crushing multiple tablets together (84% of hospitals) using a pestle and mortar (87%) and mixing into jam (72%) or water (64%). Only 7 hospitals reported modifications in the pharmacy (many small hospitals do not employ a pharmacist). 17 medications modified in the pharmacy were all modified for children because of the lack of commercial preparations.

Conclusion:

Commercial medication dosage forms are altered in Queensland hospitals, including medications for which serious adverse effects may arise from the delivery of toxic or subtherapeutic doses. Pharmacists can contribute to the education of nurses to raise awareness of problems resulting from altering medication dosage forms. Education of doctors is also needed to raise awareness of prescribing alternative dosage forms that may either be commercially available or prepared by the pharmacy as an extemporaneous preparation.

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