title: Modifying medication for people with swallowing difficulties can be fatal.
abstract: Studies on elderly chronic sick indicate that up to a quarter of patients have swallowing difficulties. Indeed, non-compliance with prescribed medicines is a major barrier to treatment. Patients are sometimes advised to crush tablets; however, crushing, opening or chewing modified-release or enteric-coated medicine can mean the patient receives a large dose of the drug relatively quickly which can produce potentially toxic blood levels. In addition, some medicines become unstable once exposed to the environment. This article explains the reasons why medicines should be taken as directed - modifying them can have deadly consequences. This article examines nurses responsibilities and liabilities in this regard.