Solid Medication Dosage Form Modification at the Bedside and in the Pharmacy of Queensland Hospitals

Abstract

It is common practice to alter the dose form of solid medications to make them easier to administer to individuals who have
difficulty swallowing.
The goal of this study is to catalog the types of medication changes done in Queensland hospitals, both at the bedside and at the
pharmacy.
Method: 97 hospitals in Queensland (both urban and rural) were issued a self-report survey. The majority (n = 31, or 79%) of
the hospitals that responded said that changes were made to drugs at the patient's bedside. At the bedside, 73 different drugs
were adjusted. The majority of the capsules and tablets were of the standard-release kind. In addition, 11 hospitals reported
crushing drugs having a narrow therapeutic index, and 8 reported crushing modified-release dose forms. Most of the time,
numerous pills were crushed with a pestle and mortar (84% of hospitals) and then mixed with jam (72% of hospitals) or water
(66% of hospitals) at the bedside to make them suitable for adults. As many smaller hospitals do not employ a pharmacist, only
7 reported pharmacy changes. Due to the unavailability of commercial formulations, the pharmacy adapted 17 drugs
specifically for children.
In conclusion, Queensland hospitals adjust the dosage forms of commercial pharmaceuticals, especially those with the potential
for toxic or subtherapeutic amounts to have harmful consequences. Nurses may benefit from pharmacists' involvement in their
education by learning more about the risks associated with changing the dose forms of medications. Prescribers need to be
made more aware of the availability of non-standard dose forms, which may be purchased from drug companies or created on
the spot by pharmacists.