Unsafe Medication Practices Play Harmful Role in Feeding Tube Errors
Feeding tube related neglect ranks high as one of the many care issues occurring throughout U.S. nursing homes today. Many facilities fail to commit the time and staffing to allow for extra nutritional care such as hand-feeding. There is also a temptation to overuse the tubes simply for facility cost-savings, regardless of the resident’s best interest. The Institute for Safe Medication Practices reports nearly one-third of nursing home residents with advanced cognitive impairments, such as dementia, receive their daily nutrients and medications through feeding tubes. Unfortunately, those familiar with basic elder abuse scenarios understand that residents with mental impairments and those who require extra care with daily activities such as feeding, grooming, and using the bathroom are always far more likely to fall victim to neglect.
Most feeding tubes are inserted during an acute-care hospitalization and remain in use after a discharge. But feeding tubes can cause serious patient harm including infections like pressure sores, depression, and death if not necessary or handled with the specialized care required to keep them clean and in proper use. One underreported hazard of these tubes occurs during the preparation or administering of daily medications. As noted by Joseph Boullata, PharmD, BCNSP, in an article published by the National Institutes of Health titled, “Drug Administration Through an Enteral Feeding Tube,” these four common errors can occur while administering drugs via feeding tube.
- Route: It should NOT be assumed a medication intended to be taken by mouth can be safely administered through a feeding tube. The drug’s physical and chemical properties control its release and subsequent absorption, effectiveness, or toxicity.
- Absorption: Many drugs must be administered into the stomach or duodenum so they can be properly dissolved by gastric juices, bile, and pancreatic enzymes and fully absorbed through the intestines.
- Preparation: Oral medications must be prepared for enteral administration. Tablets must be crushed and diluted, capsules must be opened so the contents can be diluted, and even many commercially available liquid forms of drugs should be further diluted. Many extended- or delayed-release medications, or those with coatings should not.
- Administration: Compatibility of multiple drugs administered together can also be a problem, particularly if two or more drugs are crushed and mixed before administration. Mixing two or more drugs, whether solid or liquid forms, creates a brand-new, unknown entity with unpredictability.
Feeding tube medication errors can lead to serious injury or death. Nursing homes and staff must be held accountable for these horrible failures when charged to properly care for and pay attention to their residents.
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