By Hannah Allen, SLP, St. Joseph’s Villa, Salt Lake City, UT
The Milestone Market SLPs get together for an SLP call once a month to share clinical ideas. During our last call, I was able to lead a discussion about considerations to include in our clinical thinking process when we recommend alternative forms of medication administration due to dysphagia. My husband is a clinical pharmacist who works in the ICU setting and is often involved in determining appropriate adjustments made to medications when patients are not able to take them orally, or not able to take them whole with liquid. He was able to share some great information that can be very helpful in our SLPs teaming up with and supporting Nursing with medication administration.
For example, we discussed how recommendations for crushed medications, or medications taken in any alternative forms, may be affecting the efficacy of the patient’s medication management if appropriate adjustments are not made by a pharmacist. Many medications are OK to be crushed, but some are not. If we crush them, this may make the Therapy of the medications ineffective or less effective. In some cases (such as in the case of seizure medications), we may also have the potential to cause harm. In other cases (such as Parkinson’s medications), we may be making their medications ineffective or less effective, which may decrease the actual therapeutic benefit they get from any of their PT/OT/SLP interventions.
The best option is to make sure we (or someone) is consulting the pharmacist to ensure medications are compatible with crushing. If they are not, a pharmacist may have suggestions on adjustments or changes to medications that will facilitate the safest form of delivery while maintaining medication efficacy. Some of us may have something like this in place in our facilities already, but some of us may not. This may be a process to build into our practice and the procedures of our facilities as we recommend alternative medication administration methods for our patients with dysphagia.
Below are some of the resources that were shared:
Podcast Episode: Swallow Your Pride Episode 173 — Crushing Meds: What’s an SLP to Do?
ISMP Do Not Crush List:
Blog Post by Karen Sheffler all about Pill Dysphagia
-Article on effects of thickened liquids and puree on medication absorption
-PILL-5 Questionnaire, a patient-reported outcome measure; may be a good measure to utilize when we get consulted specifically for patients struggling with medications.
-Show Notes for the Podcast episode with many of the same resources and a quick rundown of the episode in written form