About the "do not crush" medications

I am working in a LTC, there are medications labeled " do not crush". I told my patient this medication is not supposed to be crushed or the capsule is not supposed to be opened, she said: I cannot swallow it whole! What should I do? if the State people is here watching me, what should I do?

Thanks!
Some come in a suspension. Which meds?

Yes,you call the doc and ask to have it changed to a liquid or a perishable form

Quote from wongshuweiI am working in a LTC, there are medications labeled " do not crush". I told my patient this medication is not supposed to be crushed or the capsule is not supposed to be opened, she said: I cannot swallow it whole! What should I do? if the State people is here watching me, what should I do?Thanks!

I am a new grad, and I saw the past days that the "do not crush" medication were administered since it was ordered. And most of the patients' medications are crushed in apple sauce. I just feel so overwhelmed that 1 nurse for 48 patients and so many things that the seasoned nurses doing are not supposed to be done that way, and I cannot say anything. They would tell you things like they know what they are talking about, and they would stop me doing what's right, which they think it's unnecessary or that's not what they have been doing. I feel so unsafe practicing there, it's not safe for me, it's not safe for the patients! But it seems so hard for me to find a job, because I am a new grad with an ADN...Just ranting

Quote from wongshuweiI am a new grad, and I saw the past days that the "do not crush" medication were administered since it was ordered. And most of the patients' medications are crushed in apple sauce. I just feel so overwhelmed that 1 nurse for 48 patients and so many things that the seasoned nurses doing are not supposed to be done that way, and I cannot say anything. They would tell you things like they know what they are talking about, and they would stop me doing what's right, which they think it's unnecessary or that's not what they have been doing. I feel so unsafe practicing there, it's not safe for me, it's not safe for the patients! But it seems so hard for me to find a job, because I am a new grad with an ADN...Just ranting

Quote from macawakeI can easily see how you'd feel overwhelmed with 48 patients to care for. I would too, and I'm not a new grad. Personally I wouldn't trust the word of another nurse about crushing a "do not crush pill" since I am personally responsible, both legally and ethically, for what I do as a nurse. I'd contact the provider and also read the drug guide since providers are human too, and can make mistakes. I know you know this, or you wouldn't be here asking for advice. I'm not lecturing you, just sharing my thought process.Sometimes it might actually be acceptable to crush a "do not crush" medication and experienced nurses may know when this is, but sometimes it really isn't. The important part is finding out before doing it. After you gain some experience you'll be more familiar with the most common meds you administer and it gets a bit easier. When I was a new grad I remember one case where the nurses during previous shifts had administered several doses of p.o. Clindamycin to a patient who had difficulties swallowing by breaking open the capsule and pouring the contents in applesauce. The patient's complaint of a sore/painful throat was noted in the chart. Small wonder I say... So yes, even experienced nurses sometimes make mistakes. It can be stress, fatigue, deficient knowledge or lack of diligence. Know Thy Drugs.. Good luck OP!

Sort of a long these lines: At my facility we often give patients potassium, which comes in horse-pill sizes. The note in the emar order says "do not crush or chew," but goes on to say it can be dissolved in water. What?? What's the difference? If we can dissolve it in water (yuck), why not crush it and administer in applesauce?

K-Lor can be and should be dissolved in water. Ive never heard of the K-tab/Kdur (pill) being dissolved in water. Ive heard of the capsule being opened and poured on applesauce, but thats not the ideal. Whats your research?Quote from PA_RN87Sort of a long these lines: At my facility we often give patients potassium, which comes in horse-pill sizes. The note in the emar order says "do not crush or chew," but goes on to say it can be dissolved in water. What?? What's the difference? If we can dissolve it in water (yuck), why not crush it and administer in applesauce?

Quote from wongshuweiI am working in a LTC, there are medications labeled " do not crush". I told my patient this medication is not supposed to be crushed or the capsule is not supposed to be opened, she said: I cannot swallow it whole! What should I do? if the State people is here watching me, what should I do?Thanks!

As long as you dont crush the "micro beads" ( my words not what you really call them) it's fine to dissolve once disolved looks like salt

Working in LTC for years, I've frequently come upon do not crush/chew meds and patient who can't swallow pills. (yet they can swallow food no problem.) Depending on the person I would put it either in applesause or in a pudding or custard and at times ice cream. Ofen pudding was better because it was thicker and the med stayed in the pudding instead of sliding out and being seperate from the applesause. I'd follow it by a nice big sip of a supplement drink/milk shake. But my tried and true was pudding. Worked like a charm for the majority of my patients.If that didn't work, a call to the doctor for a liquid alternative was warrented.

When I come across a med that cannot be crushed and it's ordered for a patient who takes all of the meds crushed I will first try it whole in pudding, if they still cannot swallow it I will call the MD and ask for an order for an equivalent med that can be crushed. Or if it can be d/c'd all together. Some meds can be opened and given as long as they're not chewed ie: omeprazole. And the huge KCL pill can be dissolved in water, I add just a tiny bit so the pill dissolves down to a lump of sand consistency then mix it with pudding.