Crushing Medications AHCA Regulation

I received a question the other day that requested:

If it was ok to crush medications and place the crushed drugs into applesauce to be given to a resident?

Let us break the question down.... .

1. Can medications be crushed?

Yes, BUT you must have a physician's order stating so.

2. Who can crush medications?

A non-licensed practitioner (Med tech,CNA) may as long as they have their necessary Assistance with medications training up to date.

Legislation

For quantifying a prescribed amount of liquid medicine or breaking a scored tablet computer or crushing a tablet as prescribed;

Next question

1. Is placing crushed medication in applesauce allowed?

Response: It Depends

First, we must evaluate why is the medication being placed into the applesauce?

In most cases the reason why I hear is....

The resident has dementia and will not take the tablets or spits them out.

If that is the reason why the answer to"Could you put the crushed medications in the applesauce of this resident with dementia" would be only a licensed professional (RN LPN) Can put the crushed drugs in the applesauce.

Your unlicensed staff (CNA,HHA,Med Tech, Administrator) CAN NOT set the crushed medications within the resident's applesauce.

At any time you have a resident with dementia,Alzheimer's or cognitive impairment that your unlicensed staff cannot follow the proper medication assistance regulations and consequently cannot assist this resident with medications period. Just a licensed professional can assist these residents.

Why is that?

Let us look at the law

(a) Taking the medicine, in its previously dispensed, properly labeled container, such as an insulin syringe that is prefilled with the proper dosage by a pharmacist and an insulin pen That's pre packed from the producer, from where It's stored, and bringing it to the resident;

(b) In the presence of the resident, reading the tag, starting the container, eliminating a prescribed amount of medication from the container, and shutting the container;

(c) Placing an oral dose in the resident's hand or putting the dosage in a different container and assisting the resident by lifting the container for their mouth;

(d) Applying topical medications;

(e) Returning the medicine container to appropriate storage;

(f) Maintaining a record of when a resident receives assistance with self-administration

Of medication using a Drug Tracking Record (MOR);

(b) In addition to the specifications of Section 429.256(3), F.S., help with self-administration of medication includes reading the drug label aloud and verbally prompting a resident to take medications as prescribed.

(c) so as to facilitate assistance with self-administration, trained employees may prepare and make available such items as water, juice, cups, and spoons. Trained staff may additionally return unused doses into the drug container. Medicine, which appears to have been polluted, must not be returned into the container.

(d) Trained staff should observe the resident take the medication.Any concerns concerning the resident's response to the medication or suspected noncompliance should be reported to the resident's healthcare provider and documented in the resident's record.

(e) When a resident that receives assistance with medication is off from the center and from facility employees, the following options are available to enable the resident to take drugs as prescribed:

1.

2.

The drug may be transferred to some pill organizer pursuant to the requirements of subsection (2), and given to the resident, a friend, or family member upon leaving the center, with this fact noted in the resident's medication list; or

4. Medicines might be prescribed and dispensed in an easier to use form, for example unit dose packaging.

(f)Assist with self-administration of medicine does not include the activities detailed in Section 429.256(4), F.S.

1.

2. As used in Section 429.256(4)(h), F.S., the terms"judgment" and"discretion" mean interpreting vital indicators and evaluating or assessing a resident's illness when assisting with self-administration of drugs.

(g)All trained staff must adhere to the facility's infection control policy and procedures

Clarified Answer

Unlicensed staff are needed to read the drug label to the resident. Therefore the resident must be competent and able to comprehend what's being read to them.

If the resident has Alzheimer's, Dementia or cognitive impairment the resident is unable to comprehend what the unlicensed staff is studying to them then they can not know what's being given to them.

If the resident doesn't understand what you are giving them then Only a Licensed Professional can dispense the drugs to this resident.

Which means if the crushed drugs are being placed in the applesauce because that's the only way your resident with dementia may require the medications then only a certified practitioner can help that resident.

If you have a resident that has difficulty swallowing and is competent and knows when the medication label is read to them and knows that the crushed meds are from the applesauce then your unlicensed staff may set the crushed drugs into the applesauce and give it to the resident.

Overview

To crush and dispense medications the following must be performed:

Need to have a Doctor's order to crush medications

Unlicensed and Licensed staff can crush medications.

Unlicensed staff can simply assist capable citizens with medications.

Licensed professionals can crush and dispense to all occupants.

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