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The administration of medications is a topic that troubles me. I get that they have many patients to get through, but they seem geared toward crushing because it is easier to shove a handful of pills in at once. My mom swallowed her pills at home one at a time with applesauce, but there they offered all her pills in one mouthful with a teaspoon of applesauce.... of course she couldn't swallow that and neither could I. So now her medications are crushed, some which I am uncertain should be, some which are coated because they are incredibly bitter. They are still given with only one scant teaspoon of pudding or applesauce, barely enough to moisten the powder. My concerns seem to fall on deaf ears, is it even possible to change this practice?

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A "PRN" is a medication that is given as needed i.e. Tylenol for a headache, within certain parameters defined by the prescribing practitioner. PRN is shorthand for three Latin words pro re nata or as I define it, "Per Required Need".
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"Registered Nurses, commonly called RNs, exist in all provinces across Canada. An RN holds a four-year baccalaureate degree in nursing from a Canadian university or its international equivalent.

"Licensed Practical Nurses/ Registered Practical Nurses
LPNs/RPNs hold two-year practical nursing diplomas from accredited colleges. After completion of their studies, aspiring LPNs/RPNs must complete the national licensing exam before beginning a career in health care. Once licensed, LPNs/RPNs may provide nursing services in a variety of settings including acute care, long-term extended care, home care or community care."
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WHAT is an RPN
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I agree with what most posters are saying. Yes, indeed, there are several mess that are not supposed to be crushed. Rehabs and nursing facilities should know this but common practice is seeing all mess crushed together applesauce or ice cream. I would go to the pharmacist and show him the list of her medication and have him point out the ones that can't be crushed and have those 'starred' in their charts to not be crushed. There are several blood pressure medications in which this practice is a 'no-no'.
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RNs are aware but RPNs are distributing the meds and are often more worried about getting the job done than being flexible or using common sense. Nursing homes are all about the tried and true methods despite the fact that health protocols are always changing and that one size doesn't fit all.
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The RNs should be aware of what can be crushed and what can't be.
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The pharmacy supplying the nursing home should also provide information about which medications cannot be crushed. Enteric coated tablets should not be crushed and extended release medications should not either. Again, consult with the Director of Nursing and ask the Pharmacist providing medications to the facility, if necessary.
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Edna, my chat with the duty nurse was very helpful, they actually do seem willing to work with us. Next time I speak with them I'm going to see if they are willing to divide her meds into crushed and whole, the extremely bitter mirtazapine is a relatively small pill that she was able to swallow without trouble at home. The problem that leads to crushing in the first place is because time constraints make it easier to crush and give everything in one spoonful, I'm not sure how to get around that!

TooYoung, thanks, I'm aware of the problems with long term tylenol use, but I haven't seen an alternative that isn't more problematic. Dr nixed ibuprofen, and given her chronic constipation I'm not willing to return to opioids until absolutely necessary. At 97 I'm thinking liver damage is last on a long list of health worries.
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Just something to think about: Taking Tylenol/acetaminophen on a long term basis is not good. Tylenol is very rough on the liver, especially an elderly person's liver that doesn't have the capacity to metabolize the medication as well as a younger person's liver. You may want to look into something else, or it is inevitable that your mother will sustain some sort of liver damage from the long term Tylenol.
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1. Get a list of the medications ordered, the frequency and dosage.
2. Take this list to your pharmacist and request in a typed form which ones can be crushed, which ones can be changed to a liquid or patch form.
3. Request the pharmacist to also check for innapropriate drug/drug and drug/vehicle interactions.
3. Ask the pharmacist to suggest the correct vehicle for the crushed drugs.
4. Take this completed list to the director of nurses and request this list to be posted in the patient's medication administration record.
5. I know, I know, this should be something the med nurse should ALREADY be doing. But obviously it is NOT, or you would not be raising these concerns. Another reason the patient has a hard time swallowing the crushed meds is because they TASTE BAD.
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So I went in this morning and talked to the RN about mom's medications and the strange schedule, it seems they were confused as well but were following "direction from family". Yes, I did say that she took her evening meds after supper at home, but since we ate after 6:00 that meant after 7:00. They were giving her all her nighttime meds at 4:00 in the afternoon. I was also giving her extended release acetaminophen twice a day, so they were doing the same with regular acetaminophen (at least they knew enough not to crush the extended release formula). That will now be changed to 3X daily. I hope to speak to the doctor on Thursday, but since she doesn't come on a definite schedule it may be hit or miss.
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Cwillie,
I saw the same thing when mom was in rehab

Even at her memory care now they crush meds in ice cream, yogurt or pudding

Mom has always had a hard time swallowing and needs patience and encouragement

When she first got there she refused to take pills from anyone so they even crushed them in her coffee - including antibiotics -

Now she'll take them from certain of the nurses but it's another one of those things we lose control of when they're not in our care

On more than one occasion a nurse has handed me the wrong pills for mom so I did raise that up but luckily mom doesn't take nearly as many meds as some folks
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