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4 Crushing has also been found to impact dosage in varying degrees according to the crushing device used, 5 and improper cleaning of crushing devices introduces risk of cross-contamination and potential allergic reactions in patients.

However, even when this practice is not contraindicated by the manufacturer, crushing may introduce a high risk of incomplete or variable dosing. Immediate-release medications are still commonly crushed to facilitate swallowing.

2 Despite the well-known risk of crushing controlled-release medications and general avoidance of the practice, reports of erroneous pill crushing in LTCFs and hospitals have been reported to be anywhere between 0.5–10%. Crushing destroys the release characteristics of controlled-release medications, exposing patients to risk of toxicity and even, in rare cases, death.

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The handbook cautions that for each medication provided, the caregiver should be able to answer a series of questions, including:įor patients, the direct risk of crushing lies mainly in controlled-release medications, which contain a significantly greater amount of drug than do immediate-release medications. As the name implies, the default position for caregivers is not to crush unless the therapeutic impact of crushing is understood for each specific drug tablet. The Australian Don’ t Rush to Crush Handbook, a required reference for Australian pharmacists, includes information on the impact of crushing 570 medications. As an integral part of the patient-care team, SLPs should ensure that clinicians understand the implications of crushing and mixing and adopt policies to reduce risk of variable dosing or patient harm. But crushing and mixing can alter the effect of medication and put patients at risk. If this describes your practice, you are probably used to seeing care providers crushing tablets and mixing with applesauce or other seemingly harmless things-fruit juice, pudding, thickeners-to make swallowing easier. According to AHSA, 1 SLPs working in adult settings spend about 40% of their time on swallowing issues, and even more If they work in medical or long-term care facilities (LTCFs). Swallowing issues swallow up a lot of time for speech-language pathologists.

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