Solid Medication Dosage Form Modification at the Bedside and in the Pharmacy of Queensland Hospitals

Abstract

Background: Solid medication dosage forms are regularly modified to aid medication delivery to patients that are unable to swallow them. Aim: To identify medications that are commonly modified in Queensland hospitals at the bedside and in the pharmacy and to identify how these modifications are made. Method: A self-report survey was sent to 97 hospitals of varying sizes in metropolitan and rural areas across Queensland. Results: Most (n = 31; 79%) of the responding hospitals reported that medications were modified at the bedside. 73 different medications were modified at the bedside. Most of the tablets or capsules had standard-release characteristics. 8 hospitals crushed modified-release dosage forms and 11 hospitals crushed medications with a narrow therapeutic index. At the bedside, 88% of medications were modified for adult use, mostly by crushing multiple tablets together (84% of hospitals) using a pestle and mortar (87%) and mixing into jam (72%) or water (64%). Only 7 hospitals reported modifications in the pharmacy (many small hospitals do not employ a pharmacist). 17 medications modified in the pharmacy were all modified for children because of the lack of commercial preparations.