06.01 Pill Crushing & Cutting

Overview

1. Purpose
   1. Some patients cannot swallow full pills
      1. Crush and put in applesauce
   2. Patients receiving medications via NG tube or PEG
      1. Must be crushed and dissolved in water
   3. Prescribed dose calls for a half tablet
      1. Must be scored → cut on score line
2. CANNOT be cut or crushed:
   1. Extended Release
   2. Delayed Release
   3. Enteric Coated
   4. Gelcaps/softgels
   5. Capsules with beads in them
      1. Capsules with powder can be opened and dissolved as long as they aren’t delayed release

Nursing Points

General

1. Supplies needed
   1. Pill crusher
   2. Pill cutter
   3. Prescribed medications
   4. Medicine cups for each medication

Nursing Concepts

1. Steps and Nursing Considerations
   1. Verify provider order
   2. ALWAYS follow 5 rights BEFORE preparing medication
      1. Right Patient
      2. Right Drug
      3. Right Dose
      4. Right Route
      5. Right Time
   3. ALWAYS prepare medications at the patient’s bedside
   4. Gather supplies
   5. Perform hand hygiene
   6. Don clean gloves
   7. Let the patient know what pills they will be receiving
   8. Cutting pills:
      1. Open pill cutter
      2. Remove pill from packaging
      3. Carefully place pill in the cutter so that the scoring line lines up with the blade
      4. Close the cutter firmly
      5. Open the cutter and drop ½ into a medicine cup
      6. Dispose of the other ½ appropriately (facility policy)
   9. Crushing pills:
      1. One medication at a time
      2. Open pill crusher
      3. Remove pill from packaging
      4. Place pill in the crushing chamber
      5. Twist the crusher closed, push past resistance
         1. This is the pill breaking
      6. Twist back and forth a few times to ensure pill is fully crushed
      7. Open the crusher and tap the lid a few times to remove residue
      8. Transfer powder to medicine cup
   10. Repeat with each medication as appropriate, each in their own medicine cup
   11. If administering in applesauce, do it a little bit at a time, on the spoon, one medication at a time
       1. If you put it all in the full applesauce cup, and the patient doesn’t eat it all, you don’t know what they have and have not received
   12. If giving via NG tube, take medicine cups and water with you to the bedside
       1. See NG Tube Medication Administration lesson
   13. AFTER administration
       1. Document administration and patient’s response
       2. If using barcode medication administration
          1. Scan all meds before preparing
          2. Confirm administration AFTER giving to patient
   14. Discard all used supplies
   15. Remove gloves
   16. Perform hand hygiene
   17. For PRN meds, return in 15-30 minutes to evaluate response

Patient Education

1. Indication and possible side effect(s) of medication(s)
2. Signs to report to nurse or provider