Aim: To describe the difficulties faced when administering oral medication to patients with swallowing difficulties in nursing homes, the methods that are used to overcome these difficulties and their appropriateness.
Method: A self-administered questionnaire was given to all participants (n = 763) at eight regional study days for nurses employed in independent nursing homes. The questionnaire included sections on respondent and nursing home demographics, extent of and methods used to overcome swallowing difficulties, experience of overcoming swallowing difficulties and nurses' opinions on the ease of changing prescriptions to liquid formulations.
Results: Of 763 questionnaires, 540 (70.8 per cent) were returned completed. On average 15 per cent of all residents had difficulty swallowing tablets and capsules, 5 per cent regularly spat out their medication and 1 per cent hid it. Hiding medication in food was reported by 56.5 per cent (n = 305) of respondents, 26.9 per cent (n = 145) omitted the dose, 61.3 per cent (n = 331) crushed or opened medication before administration and 87.6 per cent (n = 473) obtained liquid alternatives. Crushing or opening of medication (unlicensed administration) took place in more than 80 per cent of all nursing homes on at least a weekly basis. The majority of nurses (n = 487, 90.2 per cent) would not be reluctant to ask the prescriber for a liquid alternative, however, 58 per cent (193 out of 333) stated that the prescriber might recommend that medicines be crushed or opened, and cost was stated to be a consideration in this process by 62 per cent (n = 335) of nurses.
Conclusion: The crushing or opening of medication results in unlicensed administration. Liability lies solely with the nurse if the action was unauthorised and is shared with the prescriber if it had been authorised. With the availability of most oral medicines as a liquid formulation, the majority of reported crushing or opening that is taking place is unnecessary. In many instances this is because of prescriber reluctance to change the prescription. Nurses choosing to administer medication via a non-licensed method should ensure that all other avenues have been considered and appropriate advice sought. Where unlicensed administration is authorised by the prescriber, a written and signed record of this should be obtained.