Administration of medicines to patients with dysphagia

The most appropriate administration of oral medicines for patients with dysphagia presents many challenges for prescribers. Despite this and the estimated prevalence of the condition, healthcare professionals receive little in the way of training or practical guidance.

Several of these challenges were highlighted by a Patients Association survey which investigated the medicines related care of residents with dysphagia in UK care homes96.

The Patients Association study96, based on a survey of 30 care homes, identified that in over two-thirds of the homes the crushing, melting or dispersing of tablets was a daily necessity to assist people with swallowing difficulties to take their medication. Despite the numbers of people affected, only 10% of the homes surveyed had a specific protocol to guide staff in administering medication to people with dysphagia and only 20% had arranged training in this area in the last five years, the majority through their pharmacy.

All except two of the care homes contacted quoted awareness of issues that could be presented by the crushing of certain formulations. However, when this question was pursued, the majority of care home managers had limited knowledge of the various problems.

All care homes reported that they obtain authorisation from a doctor before crushing, melting or dispersing tablets, with twenty-four of the homes also reporting that they would ‘normally’ or ‘always’ seek advice from their pharmacist in such circumstances. Respondents to the survey suggested that cost was a factor in prescription arrangements for residents with dysphagia with over two thirds of the homes reporting that their GPs were concerned about the cost of liquid medication.