PHARMACIST INTERVENTION AND PREPARATION OF MANUAL IN THE ADMINISTRATION OF DRUGS THROUGH ENTERAL FEEDING TUBE
Objective: To monitor errors in current practice and prepare a manual for proper drug administration through the enteral feeding tube.
Methods: It is a prospective observational study conducted for a period of 6 mo in eight departments. The current drug administrations were monitored and checked for the errors which include crushed non crushable solid dosage forms, each drug is not prepared separately, incorrect solution used for dilution, drugs mixed with feeding formula, each drug is not administered separately, not flushed before administration of each drug, not flushed after administration of each drug and others (tablets are not crushed with proper device, motors and pestles are not cleaned frequently, spillage during crushing). Using the data, a manual was prepared and submitted to the physicians of each department.
Results: The most prominent error was found to be that the drugs were not prepared and administered separately, tube not flushed before drug administration. Uses of noncrushable tablets were high in neurology. Pantoprazole (enteric coated) and prazosin (modified release) tablets were the most commonly used noncrushable drugs.
Conclusion: The study observed the need for developing a standard protocol for drug administration through enteral feeding tube by the pharmacist along with the physician, nursing team to improve the quality of enteral therapy.
2. Van den Bemt PM, Cusell MB, Overbeeke PW, Trommelen M, Van Dooren D, Ophorst WR, et al. Quality improvement of oral medication administration in patients with enteral feeding tubes. Qual Saf Health Care 2006;15:44-7.
3. Grissinger M. Preventing errors when drugs are given via enteral feeding tubes. P T 2013;38:575-6.
4. Dashti Khavidaki S, Badri S, Eftekharzadeh SZ, Keshtkar A, Khalili H. The role of clinical pharmacist to improve medication administration through enteral feeding tubes by nurses. Int J Clin Pharm 2012;34:757-64.
5. Sohrevardi SM, Jarahzadeh MH, Mirzaei E, Mirjalili M, Tafti AD, Heydari B. Medication errors in patients with enteral feeding tubes in the intensive care unit. J Res Pharm Pract 2017;6:100-5.
6. Barbosa AP, de Paula SL, Barbosa DS, da Cunha DF. Oral drug administration by enteral tube in adults at a tertiary teaching hospital. Eur Soc Parenteral Enteral Nutr J 2012;7:e241-4.
7. Silva MJ, Cava CE, Pedroso PK, Futuro DO. Evaluation of the profile of drug therapy administered through enteral feeding tube in a general hospital in Rio de Janeiro. Braz J Pharm Sci 2011;47:331-7.
8. Presoti AR, do Nascimento MM, Marques LA. Prescription of drugs to be administered through feeding tubes in a Brazilian hospital: profi le and qualifi cation. J Gen Pract 2013;1:112.
9. Heineck I, Bueno D, Heydrich J. Study on the use of drugs in patients with enteral feeding tubes. Pharm World Sci 2009;31:145-8.
10. Emami S, Hamishehkar H, Mahmoodpoor A, Mashayekhi S, Asgharian P. Errors of oral medication administration in a patient with enteral feeding tube. J Res Pharm Pract 2012;1:37-40.
11. NICE Clinical Guidelines, No. 32. Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. National Collaborating Centre for Acute Care (UK); 2006.
12. Heydrich J, Heineck I, Bueno D. Observation of preparation and administration of drugs by nursing assistants in patients with enteral feeding tube. Braz J Pharm Sci 2009;45:117-20.
13. Bankhead R, Boullata J, Brantley S, Corkins M, Guenter P, Krenitsky J, et al. ASPEN enteral nutrition practice recommendations. J Parenter Enteral Nutr 2009;33:122-67.
14. Beckwith MC, Barton RG, Graves C. A guide to drug therapy in patients with enteral feeding tubes: dosage form selection and administration methods. Hospital Pharm 1997;32:57-64.
15. Belknap DC, Seifert CF, Petermann M. Administration of medications through enteral feeding catheters. Am J Crit Care 1997;6:382-92.
16. White R, Bradnam V. Handbook of drug administration via enteral feeding tubes. 3rd ed. London: Pharmaceutical Press; 2015.
17. Jen Smyth. Senior Pharmacist. editors. The NEWT Guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties. 3rd edition. February; 2015. Available from: http://www.newtguidelines.com/ AdminEnteralFeedingTubes.html [Last accessed on 10 Feb 2015].
18. Sohrevardi SM, Jarahzadeh MH, Mirzaei E, Mirjalili M, Tafti AD, Heydari B. Medication errors in patients with enteral feeding tubes in the intensive care unit. J Res Pharm Pract 2017;6:100-5.