Running head: THINK BEFORE YOU CRUSH: MEDICATION 1

Think Before you Crush: Medication Errors Related to Enteric Coated Medications

Evonne Piazza

University of South Florida

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Think Before you Crush: Medication Errors Related to Enteric Coating Medications

As nurses, our job is to care for individuals, communities, and families so they may

reach, preserve, or recover optimal health and quality of life. To ensure that nurses are bringing

their patients to their optimal level of health, is it important to administer all of medications

safely. One factor that I believe is a potential medication error than can have drastic effects on

many patients health is whether nurses check to see if a certain medication has enteric coating.

This is important in nursing because many nurses may crush the medication for patients to make

it easier for them to take. However, the crushed pill will have a different reaction to the patient

due to the chemical composition of the pill being changed (Emami, Hamishekar, Mahmoodpoor,

Simin, Mashayekhi, & Asgharian, 2012).

Controlled release and sustained-release preparations enclose a significantly larger

amount of active drug than the regular-release equivalents. The surrounding substance enclosing

the drug is a specially designed matrix that is destroyed when crushed (Zhu, Xu, Wang, Jin,

Wang, & Zhou, 2012). Enteric coating medication is something that nurses must be aware of

when administering medications to their patients. If a nurse fails to acknowledge the enteric

coating and crushes the medication, it can potentially lead to fatal effects for their patients.

According to the American Nurses Association (ANA), a situation arose where a nurse from the

critical care unit was in a haste trying to catch up with her morning medications. One of her

patients had required multiple procedures that morning which put her behind her normal routine.

This patient was intubated, and the nurse decided to administer his calcium channel blocker

through the patients nasogastric tube. Unfortunately, the nurse failed to notice the Do not

crush warning on the electronic medication administration record (MAR). About an hour later,
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the patients heart rate had slowed to asystole and died (Anderson & Townsend 2015). It is

important for nurses to utilize interventions that will help avoid this problem throughout their

practice. One intervention is for the nurse to double check the MAR to see if any medication has

Controlled- release, Sustained- release, or EC written on the medication order. All of these

mean that the medication has enteric coating and should not be crushed when administering the

drug to the patient. In addition, enteric coating tablets are usually not able to be crushed easily

and are commonly broken off into little pieces when they are. These small pieces bind together

when water is added to the mixture and increases the risk of tube occlusion (Emami et al, 2012).

If a situation like this occurs in the hospital it could result in serious adverse effects from the

drug or even death. Unfortunately, a study in 2012 has showed how uneducated personnel,

including nurses, were about information pertaining to enteric coated medication, especially

when administering these medications to patients with NG tubes (Zhu et al, 2012).

Throughout my clinical experience thus far, I fear that the medication error I am most

likely to exhibit is administering the incorrect dose to the patient. One intervention I can utilize

in hopes of preventing myself from administering the incorrect dose to a patient is to always

double check the medication dose with the MAR. The MAR can be used to check the

medications correct time, date, route of administration of the prescribed medication as well as

the patients identity. Utilizing the MAR while in process of administering medications will help

prevent nurses from administering the incorrect dose. While viewing the MAR, the nurse scans

the medication prescribed before administering it to the patient and the nurse will be

acknowledged whether its the right dose, drug, and time for this medication to be given. Another

intervention I can fulfill to prevent administering the incorrect dose it to ensure I have a suitable

environment to work in. Researchers conducted a study in 2014 to determine whether there was a
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correlation between the activity in the clinical environment to the nature and frequency of

medication errors. The prevalence of medication errors in the emergency department (ED)

showed 41.2% for failure to apply patient ID bands, 12.2% for failure to document allergy status,

and 38.4% for errors of omission. This study reflected how the frequency of medication errors

was affected by ED occupancy. When over 50% of the rooms were occupied, medication errors

were found to become more common. Staffing in the ED also affected the frequency of

medication errors, this study showed how there was an increase in failure to give patient their ID

bands and errors of omission when there were infilled nursing deficits and low levels of senior

medical staff associated with increased errors of omission. All in all, this study reflected how

medication errors related to, allergies, patient identification and medication omissions occur

more frequently in the ED when it is busy, and when the staffing is not at the minimum require

staffing levels (Scott & Botti, 2014). Therefore, it is important for me to apply interventions to

help avoid myself from giving the incorrect does of medication, especially in an environment

such as the example above. One intervention I can apply to make sure my environment is an

appropriate place to administer medication correctly is to make sure I am working in a quiet and

organized room without any interruptions when I am doing medication calculations. In addition,

I will also have another nurse check my medication calculations before I administer them to the

patient.

Medication errors are sadly seen commonly throughout the healthcare workplace. As our

role as a nurse, it is critical that we actively use safety precautions and interventions, such as the

six rights, continuously throughout our nursing career to ensure the safety of our patients. By

utilizing these interventions, we are effectively increasing our patients chances of reaching their

optimal level of health.

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References

Anderson, P., Townsend, T. (2010). Medication errors: Dont let them happen to you. Journal of

American Nurses Association, 5(3), 23-28. www.americannursetoday.com/medication-

errors-dont-let-them-happen-to-you/

Emami, S., Hamishehkar, H., Mahmoodpoor, A., Mashayekhi, S., & Asgharian, P. (2012). Errors

of oral medication administration in a patient with enteral feeding tube. Journal of

Research in Pharmacy Practice, 1(1), 3740. http://doi.org/10.4103/2279-042X.99677

Mitchell Scott, B., Considine, J., & Botti, M. (2014). Research paper: Medication errors in ED:

Do patient characteristics and the environment influence the nature and frequency of

medication errors?. Australasian Emergency Nursing Journal, 17167-175.

doi:10.1016/j.aenj.2014.07.004

Zhu, L.-L., Xu, L.-C., Wang, H.-Q., Jin, J.-F., Wang, H.-F., & Zhou, Q. (2012). Appropriateness

of administration of nasogastric medication and preliminary intervention. Therapeutics

and Clinical Risk Management, 8, 393401. http://doi.org/10.2147/TCRM.S37785