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Information poster for the administration
of commonly used medication in
dysphagia
Emma Lowe, Hilary Oldham, Joan Karasu, Sharon Platt
poster was Trust
appropriate; 69% said they had used it on a
Clinical service technicians, Pharmacy Department, Christie NHSthe
Foundation
Introduction
Due to the specialist nature of the Trust we see a high number of
patients with dysphagia. This can be caused by a number of
issues including; mucositis, radiotherapy, oesophageal occlusion
and high volume of tablets/capsules . Most of the medication
required by our patients is available in liquid form but some are
not, or are not stocked on the ward. This can lead to a delay in
administration while nurses are waiting for pharmacy for an
alternative or for information on whether or not the tablet can be
crushed (or capsules opened). Although information is available
to ward staff using the internet or the NEWT guide1, obtaining this
can be time consuming and not easily accessible. Pharmacy staff
are not always immediately available to offer information and a
quick reference guide on the ward could improve efficiency of the
administration process. In 2010, the NPSA released a rapid
response report on ‘Reducing harm from omitted and delayed
medicines in hospital’2 which highlights the importance of
avoiding delay in the administration of medicines. As a team, we
thought that it would be useful to have some information
regarding tablets-crushing/capsule-opening available on the
wards. We therefore decided to carry out a service evaluation to
see if the ward staff thought this information would be helpful.
Our aim is to collate information from trusted sources (see
references) to produce a poster which will be displayed on all the
in-patient wards, identifying the mode of administration where
liquid preparations are not immediately available. Thus, when
staff require the information they will be able to use the poster as
a quick reference guide to see if the prescribed medication can
be crushed/opened, to avoid unnecessary delays in
administration.
Method
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•
•
•
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A short questionnaire was distributed to a complete
nursing shift on each of our main in-patient wards (a total
of 18 nurses), in order to gain an insight as to whether the
ward staff would find such information regarding
administering medication in dysphagia helpful
The clinical technicians discussed, analysed and identified
the most commonly prescribed medicines on the wards
within our Trust
A laminated A3 information poster of commonly prescribed
medication in the Trust was produced, following infection
control protocol and using current and accurate information
from the NEWT guide
This poster was displayed in the treatment areas on the
main in-patient wards
A month later, a second short questionnaire was then
distributed to a complete nursing shift on each of our main
in-patient wards (a total of 18 nurses), to obtain feedback
from the nursing staff
Results/Discussion
For the initial questionnaire; 72% of nurses asked said they knew
where to obtain information previously about whether a tablet can
be crushed or a capsule opened before administering; 89% of
nurses asked said they would find the poster useful; 83% said
they think such a poster would improve patient waiting time for
medication administration; and 100% said they require such
information on a regular basis. For the second questionnaire; 94%
said that they had found the poster useful; 88% said they thought
the content of
regular basis (31% had not had the opportunity to use it).
Comments from the nursing staff on the wards included; “the
poster made it easier and quicker to find the information”, “I didn’t
have to wait for pharmacy”, “improves familiarisation with
medications”, “improves care for the patient as they don’t have to
wait for their dose!”
Requirement of information on crushing/opening medication
14
12
10
8
6
4
2
0
Daily
W eekly
Monthly
Prior to poster displayed on ward
Never/ Not used yet
Use of poster
Before the poster was displayed on the wards, as an example, if
a patient was prescribed fluconazole but was unable to swallow
the capsule (which is kept as stock on the wards), the nurse
would have to contact pharmacy who would then order the liquid
formulation. This could cause a delay in the patient receiving
their treatment due to the dispensing process. The capsule can
be opened and the contents dispersed in water. The patient
would receive their medication this way until the liquid was
available on the ward. In the past the dose may have even been
omitted if the medication was required out of hours. Now with the
poster these potential delays are minimised (if the medicine is
included on the poster) until the liquid form is available.
Conclusion
The poster allows nursing staff to quickly access the information
when it is required, so that there is no delay in the patient
receiving their medication. Staff found that the poster was an
informative, useful, quick reference guide to aid adherence in the
administration of medication for patients with dysphagia. The
poster will require annual review to update.
References
1. Smythe J. The NEWT Guidelines: for administration of
medication to patients with enteral feeding tubes or
swallowing difficulties. 2nd ed. Betsi Cadwaladr University
Local Health Board (East);2010
2. National Patient safety Agency. Reducing harm from
omitted and delayed medicines in hospital. NPSA, 2010.
Available at:http://www.nrls.npsa.nhs.uk/resources/patientsafety-topics/medication-safety/?entryid45=66720&p=2
3. Joint Formulary Committee. British National Formulary
online) London: BMJ Group and Pharmaceutical Press
<http://www.medicinescomplete.com> [Accessed on 7/04/13]
Date of preparation: 23/09/13