Characterization of Enteral Administration of Medications that Should Not Be Crushed in Critically Ill Patients

Document Type

Conference Proceeding

Publication Date

10-19-2021

Publication Title

J Am Coll Clin Pharm

Abstract

Introduction: Critically ill patients often require enteral access due to the inability to intake nutrition or medications orally. Crushing extended-release or NIOSH medications may lead to patient or clinician harm. This study looks to characterize the rate of inappropriate medication administration via enteral tube access for medications that should not be crushed. Research Question or Hypothesis: Describe the rate of inappropriate medication administration via enteral tube access for medications that should not be crushed in hospitalized patients. Study Design: IRB approved, retrospective, observational study Methods: Adult patients at an academic medical center were included if hospitalized with an order for a study medication while mechanically ventilated with enteral access from 1/1/2018-12/31/2019. Study medications included extended-release cardiovascular and NIOSH medications. The primary outcome was the frequency of medication administration calculated by dividing total inappropriate medication administration by total medication administration opportunities. Administration opportunity was every scheduled administration whether administered or not. Inappropriate administration was a medication administered via enteral tube. Secondary outcomes included adverse drug effects (ADE) from 4 hours of when medications was administered. ADE were hypotension (SBP <90 mmHg) and bradycardia (<60 BPM). A Naranjo score was calculated with each ADE. Data was analyzed using descriptive statistics using Microsoft Excel. Results: Eighty-two patients were included in the study with a median enteral access duration of 5.02 (1.97-10.53) days. There was a total of 157 medication administration opportunities, of which 107 were NIOSH and 50 were cardiovascular medications. A total of 43.3% (n=68) of these doses were administered. Six patients (7.3%) experienced bradycardia or hypotension. In four ADE the Naranjo score indicated possible association and in two cases the score indicated probable association. Conclusion: Approximately one-third of patients received a medication that should not be crushed via enteral access. These results should be used to assess for the use of decision support to assist in prevention of improper medication administration.

Volume

4

Issue

12

First Page

1699

Last Page

1699

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