ArticleBMJ open2016
Effect of warning symbols in combination with education on the frequency of erroneously crushing medication in nursing homes: an uncontrolled before and after study.
Article in BMJ open, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Medication administration in aged care facilities: A mixed-methods systematic review.Journal of advanced nursing · 2025Pooled it
- Evaluation of the clinical pharmacist's effect on achieving treatment goals in patients with hypothyroidism: a randomized controlled trial.BMC endocrine disorders · 2025Trial
- Introducing the Quality Target Administration (QTAP) Profile for Enteral Feeding Tube Medications.Pharmaceutics · 2026Article
- A qualitative study exploring the views of healthcare professionals regarding patients who have difficulty swallowing medicines.International journal of clinical pharmacy · 2026Article
- Application of a screening tool to understand the medication habits of patients with swallowing difficulty: a prospective observational study.International journal of clinical pharmacy · 2025Observational
- Impact of clinical pharmacist interventions on medication administration via enteral feeding tubes in a neurology ward: a pre- and post-educational prospective study.Frontiers in pharmacology · 2025Article
- Summary of the best evidence for the management of dysphagia in elderly patients.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2024Review
- Point Prevalence Survey of Acute Hospital Patients with Difficulty Swallowing Solid Oral Dose Forms.Pharmaceutics · 2024Article
- Communicating Risks and Food Procedures through a Visual Poster for Caregivers of Patients with Dysphagia in Inpatient Care: Usability and Impact.Healthcare (Basel, Switzerland) · 2024Article
- Adult Patients with Difficulty Swallowing Oral Dosage Forms: A Systematic Review of the Quantitative Literature.Pharmacy (Basel, Switzerland) · 2023Review
- Determine the impact of a structured pharmacist-led medication review - a controlled intervention study to optimise medication safety for residents in long-term care facilities.BMC geriatrics · 2022Article
- Clinical Decision Support System-Assisted Pharmacy Intervention Reduces Feeding Tube-Related Medication Errors in Hospitalized Patients: A Focus on Medication Suitable for Feeding-Tube Administration.JPEN. Journal of parenteral and enteral nutrition · 2021Article
- Better Medicines for Older Patients: Considerations between Patient Characteristics and Solid Oral Dosage Form Designs to Improve Swallowing Experience.Pharmaceutics · 2020Review
- Appropriateness of oral dosage form modification for aged care residents: a video-recorded observational study.International journal of clinical pharmacy · 2020Observational
- Orodispersible films as a personalized dosage form for nursing home residents, an exploratory study.International journal of clinical pharmacy · 2020Article
- Pilot of a Charter to Improve Management of Medicines and Oral Care for Residents with Dysphagia in Care Homes.Geriatrics (Basel, Switzerland) · 2018Article
- Development and evaluation of an algorithm-based tool for Medication Management in nursing homes: the AMBER study protocol.BMJ open · 2018Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesResidents of nursing homes often have difficulty swallowing (dysphagia), which complicates the administration of solid oral dosage formulations. Erroneously crushing medication is common, but few interventions have been tested to improve medication safety. Therefore, we evaluated the effect of warning symbols in combination with education on the frequency of erroneously crushing medication in nursing homes.
settingThis was a prospective uncontrolled intervention study with a preintervention and postintervention measurement. The study was conducted on 18 wards (total of 200 beds) in 3 nursing homes in the North of the Netherlands.
participantsWe observed 36 nurses/nursing assistants (92% female; 92% nursing assistants) administering medication to 197 patients (62.9% female; mean age 81.6).
interventionThe intervention consisted of a set of warning symbols printed on each patient's unit dose packaging indicating whether or not a medication could be crushed as well as education of ward staff (lectures, newsletter and poster). PRIMARY OUTCOME MEASURE: The relative risk (RR) of a crushing error occurring in the postintervention period compared to the preintervention period. A crushing error was defined as the crushing of a medication considered unsuitable to be crushed based on standard reference sources. Data were collected using direct (disguised) observation of nurses during drug administration.
resultsThe crushing error rate decreased from 3.1% (21 wrongly crushed medicines out of 681 administrations) to 0.5% (3/636), RR=0.15 (95% CI 0.05 to 0.51). Likewise, there was a significant reduction using data from patients with swallowing difficulties only, 87.5% (21 errors/24 medications) to 30.0% (3/10) (RR 0.34, 95% CI 0.13 to 0.89). Medications which were erroneously crushed included enteric-coated formulations (eg, omeprazole), medication with regulated release systems (eg, Persantin; dipyridamol) and toxic substances (eg, finasteride).
conclusionsWarning symbols combined with education reduced erroneous crushing of medication, a well-known and common problem in nursing homes.
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