Don't rush to crush: audit of modification to oral medicines for patients with swallowing difficulties

Background Oral medicines are frequently modified prior to administration for patients with swallowing difficulties or enteral tubes. The current Australian guideline, the Don't Rush to Crush ( DRTC ) Handbook has been available since 2011, and this study compares practice with its recommendations. Aim To assess compliance with Australian guidelines for the preparation of medications in patients who are unable to swallow solid oral medicines, and to provide nursing education as necessary to improve practice. Method An observational audit was undertaken during morning medication rounds in an 18‐bed medical oncology ward over 4 weeks. For each occasion that an oral medicine was modified, the preparation method was assessed against recommendations in the DRTC Handbook for appropriateness. A number of education strategies were implemented with support and input from senior nursing staff focusing on medication modification for patients with fine‐bore nasogastric tubes. A re‐audit was undertaken to assess practice improvement. Results Education improved the proportion of medications prepared safely from 45% (37/82) to 91% (68/75) and those prepared according to the optimal method of preparation from 33% (27/82) to 60% (45/75). In the initial audit, 52% (43/82) of medications modified were strained prior to patient administration. Practical and collaborative education eliminated the straining of medications, and guidelines for difficult medications for patients with nasogastric tubes were developed. Conclusion Collaborative education that is practical and targeted can improve how oral medicines are modified for patients with swallowing difficulties and enteral tubes.