01/25/2024

Survey Tip of the Week: Crushed Medications

According to the National Institute of Health (NIH), dysphasia is prevalent in long-term care. Administering crushed medications mixed with a soft food, liquid vehicle, or via a feeding tube is a common strategy to circumvent swallowing difficulties in patients with dysphagia. However, inappropriate medication use and improper crushing technique can reduce the medication dose a patient receives, alter medication pharmacokinetics and pharmacodynamics, and compromise treatment efficacy and patient safety. NIH goes on to discuss challenges and considerations in the article “Crushed Tablet Administration for Patients with Dysphagia and Enteral Feeding.”

The Centers for Medicare & Medicaid Services (CMS) provides guidance on crushing medications in the State Operations Manual (SOM) Appendix PP. CMS states facilities should use a person-centered, individualized approach to administering all medications. Medications should be administered in accordance with physician orders, manufacturer guidance, standards of practices, and in collaboration with pharmacist recommendations.

CMS notes that the Institute for Safe Medication Practices website provides a list of oral dosage forms that should not be crushed.   

Additionally, CMS’s standard of practice states that crushed medications should not be combined and given all at once via feeding tube. Crushing and combining medications may result in physical and chemical incompatibilities leading to an altered therapeutic response, or cause feeding tube occlusions when the crushed medications are combined and administered via feeding tube. Flushing the feeding tube between each medication is also standard of practice. 

LeadingAge Ohio encourages members to use the Medication Administration Pathway to evaluate compliance with medication administration standards of practice. The pathways can be found on the CMS Nursing Home webpage and under the downloads section on this CMS webpage. LeadingAge has developed webinars and resources on the requirements of participation available on the LeadingAge learning hub. LeadingAge continues to add QuickCasts on the regulatory groups. Updated resources have also been added on the Nursing Home RoP Tools and Resources webpage.  

For more information about the updated requirements of participation and citations occurring in Ohio, please join us on the monthly STAT: Survey Tips and Tactics call. Register now for the February 14 call at 11:00AM. LeadingAge Ohio is sharing tips to assist members during the survey process. Send questions you would like addressed in future Tips of the Week to Stephanie DeWees at sdewees@leadingageohio.org.