title: Impact of recommendations on crushing medications in geriatrics: from prescription to administration.
abstract: The practice of crushing drugs is very common in geriatric units. In 2009 a first study, performed in all geriatric units of a university hospital, showed that numerous errors were made during prescription, preparation and administration. The aim of this second prospective study was to assess the impact of regional and national recommendations in the same geriatric units. A survey of 719 patients (85.3 ± 6.7 years) was performed in 2013. For each patient who received crushed drugs, we recorded the reason the drugs were crushed, pharmacological classes, galenic presentations and the technique used for preparation and administration. Results were compared to the previous study. The number of patients receiving drugs after crushing was significantly lower than in the previous study (22.9% vs. 32.3%, P < 0.001). The number of crushed drugs was lower too (594 per 165 patients vs. 966 per 224 patients (P < 0.01). The main indication for crushing drugs remained swallowing disorders. The dosage form prevented crushing in 24.9% of drugs (vs. 42.0% in 2009, P < 0.001), but the drugs generally remained crushed all together. A mortar was used less often (38.6% vs. 92.6%, P < 0.001), with preference for individual-specific cups (56.1%). Mortars were more often cleaned between each patient (56.0% vs. 11.6%). The vehicle was more often neutral (water 88.5% vs. 5.7%, P < 0.001). This second study shows that regional and national recommendations have led to an overall improvement of practices for crushing drugs. Technical improvements are still possible, in association with appropriate pharmacological studies.
authors: Médecine Interne Gériatrie Thérapeutique, CHU de Rouen, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France.
authors: Gwladys
authors: G
authors: Bourdenet
authors: Gériatrie, CHU de Rouen, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France.
authors: Sophie
authors: S
authors: Giraud
authors: Médecine Interne Gériatrie Thérapeutique, CHU de Rouen, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France.
authors: Marion
authors: M
authors: Artur
authors: Médecine Interne Gériatrie Thérapeutique, CHU de Rouen, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France.
authors: Sophie
authors: S
authors: Dutertre
authors: Médecine Interne Gériatrie Thérapeutique, CHU de Rouen, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France.
authors: Marie
authors: M
authors: Dufour
authors: OMEDIT de Haute-Normandie, 1 rue de Germont, 76031, Rouen Cedex, France.
authors: Marie
authors: M
authors: Lefèbvre-Caussin
authors: Médecine Interne Gériatrie Thérapeutique, CHU de Rouen, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France.
authors: Alice
authors: A
authors: Proux
authors: Département de Pharmacie, CHU de Rouen, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France.
authors: Sandrine
authors: S
authors: Philippe
authors: Médecine Interne Gériatrie Thérapeutique, CHU de Rouen, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France.
authors: Corinne
authors: C
authors: Capet
authors: Département de Pharmacie, CHU de Rouen, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France.
authors: Magali
authors: M
authors: Fontaine-Adam
authors: Institution Boucicaut, CHU de Rouen, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France.
authors: Karine
authors: K
authors: Kadri
authors: Médecine Interne Gériatrie Thérapeutique, CHU de Rouen, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France.
authors: Isabelle
authors: I
authors: Landrin
authors: Soins de Suite et Réadaptation CHU de Rouen, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France.
authors: Emmanuelle
authors: E
authors: Gréboval
authors: Gériatrie, CHU de Rouen, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France.
authors: Myriam
authors: M
authors: Touflet
authors: Gériatrie, CHU de Rouen, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France.
authors: Jules
authors: J
authors: Nanfack
authors: Département de Pharmacie, CHU de Rouen, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France.
authors: Christine
authors: C
authors: Tharasse
authors: Département de Pharmacie, CHU de Rouen, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France.
authors: Rémi
authors: R
authors: Varin
authors: OMEDIT de Haute-Normandie, 1 rue de Germont, 76031, Rouen Cedex, France.
authors: Elise
authors: E
authors: Rémy
authors: Département de Pharmacie, CHU de Rouen, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France.
authors: Mikaël
authors: M
authors: Daouphars
authors: Médecine Interne Gériatrie Thérapeutique, CHU de Rouen, Rouen University Hospital, 1 rue de Germont, 76031, Rouen Cedex, France.|OMEDIT de Haute-Normandie, 1 rue de Germont, 76031, Rouen Cedex, France.
authors: Jean
authors: J
authors: Doucet
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D002626:Chemistry, Pharmaceutical; D003680:Deglutition Disorders / Q000503:physiopathology*; D004339:Drug Compounding / Q000592:standards*; D011307:Drug Prescriptions; D005260:Female; D005602:France; D005853:Geriatrics / Q000592:standards*; D019983:Guideline Adherence / Q000592:standards; D006785:Hospitals, University; D006801:Humans; D008297:Male; D004364:Pharmaceutical Preparations / Q000008:administration & dosage* / Q000737:chemistry / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards; D011446:Prospective Studies; D013607:Tablets; D013997:Time Factors
chemical_list: D004364:Pharmaceutical Preparations; D013607:Tablets
keywords: crushed drugs; elderly; swallowing disorders