Reasons why pills or tablets are crushed:
(1) The patient has difficulty swallowing.
(2) The medication has an unpleasant taste or texture.
(3) A health care provider wants to administer the drug covertly to a person who has refused to take the medication.
(4) A health care facility is trying to save money.
(5) It is easier for the staff to administer.
(6) The health care provider is trying to avoid forcible parenteral administration.
Patients at risk for surreptitious administration:
(1) demented
(2) psychiatric
(3) elderly
Issues:
(1) availability of liquid formulations of the medication
(2) incompatibility of the drug with the food or liquid with which it is mixed
(3) damage to slow or timed release formulation, resulting in overdose of an electrolyte or medication rather than a slow release
(4) liability for unlicensed use if an adverse event occurs
(5) toxic effect from aerosol or cutaneous absorption of drug by the health care provider (for example, an antineoplastic agent)
(6) consequences of secrecy and/or lying
Recommendations:
(1) A person who has difficulty swallowing may be able to take the medication if sitting up straight and if plenty of water is taken.
(2) The prescribing physician should always be notified about issues surrounding the patient.
(3) In general, lying or surreptitious administration should be avoided. It may be warranted if significant exigencies are present.
(4) A pharmacist should be consulted about incompatibilities and the availability of alternative formulations.
