A practical exploration of the professional, patient and pharmaceutical aspects of medication administration in enterally fed patients

• Main Author: White, Rebecca
• Published: University of East Anglia 2017
• Subjects: 615.1
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.761553

Medication administration in dysphagic patients or those with an enteral feeding tube (EFT) is complicated with an increased risk of medication errors and complications than the general population. The range of issues that require an evidence base is broad and data are lacking, consequently much of the clinical guidance is consensus based. Following a literature review to identify the main evidence themes, an exploration of aspects of medication administration in this patient group was undertaken using survey, laboratory and literature review methods. Survey methodology was used to enable description of the reported clinical practice of relevant professionals and patients across the UK. Liquid medications subsequently identified as ‘problem’ were rheologically evaluated using a clinically derived method focussing on flow properties via EFTs. Crushing methods previously described were evaluated for dose recovery using three model drugs. Finally, a systematic review was undertaken to identify interventions that have been successfully targeted at improving medication related outcomes in this complex group of patients. Appropriate formulation choice for EFT administration exceeded 80% for both patient and nursing home cohorts. Reported medication administration practices were consistent with consensus guidance in the professional group but were not consistently applied by patient groups. The role of healthcare professionals in informing practice was inconsistent across care settings and warrants further evaluation. Laboratory assessment of liquid medication properties demonstrates a relationship between viscosity and administration difficulties. Tablet crushing methods which significantly reduce dosing accuracy were identified, and calls into question the continued use of equipment currently used for crushing tablets. A systematic review of the literature surrounding intervention strategies to improve medication related practice revealed an education and documentation based focus on preparation and administration steps with minimal evaluation of interventions targeting prescription quality. Retrospective mapping against the Theoretical Domains Framework highlighted a lack of focus on motivational factors which may negatively impact intervention sustainability. This exploration, from bedside to bench and back again, revealed that potentially suboptimal administration methods are common in clinical practice. New data and insights generated within this thesis should be translated into clinical practice to improve outcomes. However, further research is still required to understand motivations for changing practice, provide pharmaceutical data to support more specific guidance on formulation choice, and an evaluated intervention strategy to change and embed good practice, each of these aspects are a major work in their own right.