The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [541]
Figure 13.3 Medicine pot.
Tablet splitters
Commercially available tablet splitters (Figure 13.4) may increase the accuracy of tablet splitting when this activity is necessary. Tablets that are unscored, unusually thick or oddly shaped, sugar coated, enteric coated and sustained-release tablets are not suitable for splitting. Areas for consideration when using a tablet splitter include the following.
Figure 13.4 Tablet splitter.
Can the tablets be split? This must always be discussed with the pharmacy department.
Do patients have the manual dexterity to use a tablet splitter when at home?
Will splitting the tablets affect patient adherence when they are at home? Will patients skip or double dose rather than split tablets?
How will the storage of split tablets affect the stability of the tablets? What about the effect of light and air (Marriott and Nation 2002)?
Tablet crushers
Tablet crushers (Figure 13.5) can be used when a patient has swallowing difficulties and no alternative dosage form exists. Crushing tablets is usually outside the product licence. The Medicines Act 1968 states that unlicensed medicines can only be authorized by a medical or dental practitioner so if the activity of crushing tablets is going to take place, there should be discussion and agreement between the prescriber and the person who will administer the medicine. Discussion should also take place with the pharmacist to check that the tablet is suitable for crushing and that the efficacy of the medication is not changed as a result. Tablets that are enteric coated, sustained release or chewable cannot be crushed. Areas for consideration when crushing a tablet include the following.
Figure 13.5 Tablet crusher.
Can the tablet be crushed? This must always be discussed with the pharmacy department.
Will crushing make the tablet unpalatable?
Will crushing the tablet cause any adverse effects to the patient, for example burning of the oral mucosa?
Will crushing the tablet result in inaccurate dosing (Kelly and Wright 2009)?
When a tablet crusher is used, water should be added to the crushed tablet and the resulting solution drawn up using an oral syringe. The crusher should then be rinsed and the process repeated. Tablet crushers should be rinsed before and after use to prevent cross-contamination with other medicines (Fair and Proctor 2007, Smyth 2006).
When a tablet crusher has been used, it should be opened and washed under running water, dried with a tissue and left to air dry on a tissue or paper towel.
Monitored dosage systems and compliance aids
Monitored dosage systems and compliance aids, for example dosette boxes (Figure 13.6), are designed to help patients remember when to take their medication. They can also let carers know whether patients have taken their medication. The following should be considered when using these systems.
Figure 13.6 Dosette box.
They can only be used for tablets and capsules.
Medicines that are susceptible to moisture should not be put in these systems.
Light-sensitive medicines should not be put in these systems.
Medicines that are harmful when handled should not be put in these systems.
If the patient is on medications that cannot be stored in these systems, precautions should be put in place to ensure that they can cope with two systems.
If the patient’s drug regimen is not stable, consideration should be given to how easy it will be to make changes to the system.
As-required medication cannot be placed in these systems.
These systems comply with labelling and leaflet legislation so they must always be dispensed by a pharmacy department (RPSGB 2007b).
Oral syringes
If a syringe is needed to measure and administer an oral dose, an oral syringe (Figure 13.7) that cannot be attached to intravenous catheters or ports should be used. These syringes are purple in colour. All oral syringes containing oral liquid medicines must be labelled by the person who prepared the