Nurses benefit from don’t rush to crush training


yellow pills in mortar with pestle for crushing medicines

Training nurses how to use the Australian don’t rush to crush handbook significantly improves how safely medicines are given to patients in hospitals, according to a new study.

In their study, published in the June 2015 issue of the Journal of Pharmacy Practice and Research, Catherine Downey and colleagues found that introducing education for nursing staff and providing information to prescribers doubled the proportion of medicines being safely prepared and administered.

The researchers collaborated with nursing and medical staff to create the training. The nursing and medical staff appreciated the training too.

The training was introduced following a review in their hospital of how medicines were being given to patients who were unable to swallow capsules and tablets, such as those who had nasogastric tubes.

They found that only 45% of medicines were being prepared safely.

This low figure was despite the Australian don’t rush to crush handbook, a book that details the best way to prepare medicines for people who are unable to swallow tablets or capsules, being available throughout the hospital.

During the review the researchers found a widespread practice that surprised them.

“A large proportion of medications were beings strained through gauze or a tea strainer prior to administration through nasogastric tubes and this practice was common across all nursing staff, from recent graduates to experienced nurses,” says Downey.

“In the attempt to reduce the risks of blocking a nasogastric tube, it was overlooked that straining medications could result in patients not receiving the full dose prescribed.

“Additionally, Don’t rush to crush was rarely referred to when medications were prepared for patients with swallowing difficulties or feeding tubes indicating that staff didn’t understand how valuable this is as a resource.”

After the introduction of tailored training, the proportion of optimally prepared medicines increased from 45% to 91%.

“By collaborating with senior nursing staff we tailored training to target the underlying issues: the lack of understanding of what is best practice for preparing medications for patients who are unable to swallow them whole,” Downey says.

“Nursing staff were grateful to be shown the resources available and how best to use them. Involving medical staff was also crucial in ensuring that appropriate medications were being prescribed for these patients.

“Giving concise recommendations to guide prescribers’ choice of common medications and classes was appreciated by nursing and medical staff alike.”

The Australian don’t rush to crush handbook is published by The Society of Hospital Pharmacists of Australia.

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