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INTERNAL MEDICINE

Improving Oral Medicine Administration in Patients with Swallowing Problems and Feeding Tubes

Clinical Pharmacy Coordinator, Pharmacy Department—Clinical Pharmacy Services, Hamad Medical Corporation, Doha, State of Qatar

David Woods, MPharm

Consultant Pharmacist, Pharmacy Department, University of Otago, Dunedin, New Zealand

Aisha Alsulaiti, BPharm

Clinical Pharmacist, Hamad Medical Corporation

Fathia Adheir, BPharm

Clinical Pharmacist, Hamad Medical Corporation

Nabila Al-Meer, RN PhD

Director of Nursing, Hamad Medical Corporation

Noora Obaidan, BPharm MSc PhD

Director of Pharmacy, Hamad Medical Corporation

Reprints: Dr. Hanssens, Pharmacy Department—Clinical Pharmacy Services, Hamad Medical Corporation, PO Box 3050, Doha, State of Qatar, fax 974 4392253, yhanssens{at}hmc.org.qa

BACKGROUND: Correct administration of oral medicines in patients with swallowing problems and feeding tubes remains a challenge.

OBJECTIVE: To improve drug administration in patients with swallowing problems and feeding tubes in a 1600 bed tertiary referral center in the State of Qatar.

METHODS: A questionnaire was used to evaluate the knowledge and practice of nursing staff from 6 different intensive care units (ICU). Questions assessed the respondents' knowledge of the purpose of controlled-release (CR) preparations, codes used for CR medication, the consequences of crushing these preparations, and their interactions with enteral feeds and feeding tubes. Based on the results of the questionnaire, a 2 day training program was conducted for a core group of 34 staff nurses from all units (ICU and non-ICU) and 3 nursing instructors. Following the principle of "training the trainers," the core group and the nursing instructors would widen the scope of education by running programs in the future. Lecture sessions for pharmacy staff and a monitoring tool to evaluate the practice were also developed.

RESULTS: Overall knowledge of CR codes increased from 0% to 40%, correct crushing of solid preparations from 35% to 90%, and knowledge of possible interactions with the enteral feed or feeding tubes from 51% to 88%. Correct administration of medication in patients with feeding tubes improved from 32% to 83%. The quality and value of the 2 day training course received a mean score of 96%.

CONCLUSIONS: While most nurses were aware of the purpose of CR formulations, little was known about the different codes used by drug companies and the consequences of crushing these preparations. Interactions with enteral feeds and feeding tubes were mostly overlooked. A 2 day training course followed by continuous in-service training, a lecture to pharmacy staff, and provision of supportive educational material greatly improved the overall medicine administration process in patients with swallowing problems and feeding tubes.

Key Words: crushing and cutting drugs, feeding tubes, swallowing problems

Published Online, November 28, 2006. www.theannals.com, DOI 10.1345/aph.1H342