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06.01 Pill Crushing & Cutting

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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

Reference Links

Study Tools

Video Transcript

In this video, we’re going to look at how to cut and crush pills. Usually we cut pills because the order calls for a half-dose. But, it could also be because the patient wants them to be a bit smaller. We crush pills either to put them in applesauce or something to make it easier for the patient to swallow OR because we have to give them via NG tube. Either way, make sure the medication you’re giving CAN actually be cut or crushed before you do it.

So, let’s say our provider order calls for a half tab of this medication. You’re going to open the pill cutter, then remove the pill from its packaging
Carefully place the pill in the cutter so that the scoring line lines up with the blade – don’t cut your finger!
Then close the cutter firmly, you’ll feel the pill snap.
Now open the cutter and drop ½ into a medicine cup. The other half, you can dispose of appropriately based on your facility’s policy. Make sure you close the cutter again so no one cuts themselves.
Now, if we need to crush pills, we’re going to use the crushing chamber. ANY time you’re crushing pills, you will do one medication at a time – don’t ever mix multiple meds in the crusher.

Open the pill crusher, then remove the pill from its packaging
Place the pill in the crushing chamber and twist it closed. Push past the resistance you feel – that’s just the pill breaking.
Twist it back and forth a few times to make sure the pill is fully crushed.
Open the crusher and tap the lid a few times to remove residue, then you can transfer the powder to a medicine cup.
You’re going to repeat this process with each medication you need to administer, each in their own medicine cup.
If you’re giving it in applesauce, do it a little bit at a time, on the spoon, one medication at a time. 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 haven’t received.
If you’re giving it via NG tube, you can take the medicine cups and water with you to the bedside and prep for that. Make sure you check out the NG Tube Medication Administration lesson for more about that.

If you’re ever unsure whether or not you can crush or cut a pill, check with the Pharmacist – that’s what they’re there for!

Now, go out and be your best selves today. And, as always, happy nursing!

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