Optimization of solid oral dosage form administration to patients with swallowing difficulties: An integrative review.

AIM: To appraise and synthesize research investigating optimizing the administration of solid oral dosage forms (SODFs) to adults with swallowing difficulties. DESIGN: An integrative review. METHODS: An electronic search was conducted on Medical Literature Analysis and Retrieval System Online (Public Medline interface), Elsevier SciVerse Scopus and Scientific Electronic Library Online (updated February 2023). Restriction regarding the publication date was not considered for the inclusion of records. Studies addressing risks, general aspects, recommendations about patient postural adjustments, swallowing techniques, swallowing aids and aspects of concealment of SODFs were included. RESULTS: Fifty-three records published between 2002 and 2021 were included. The main administration risks were aspiration, asphyxia and solid oral dosage form-induced oral/oesophageal mucosal lesions. The most frequent general aspect reported was administering one oral dosage form at a time. The sitting position was the most patient postural adjustment mentioned. The most frequently reported solid oral dosage form swallowing technique was the lean-forward method for capsules. Solid oral dosage form swallowing aids cited: tongue and throat lubricant and solid oral dosage form coating device, swallowing cup and swallowing straw. CONCLUSION: The literature data on administering SODFs for adults with swallowing difficulties were appraised and synthesized. Some aspects, for example, not administering SODFs simultaneously, can make swallowing safer. Postural adjustments and solid oral dosage form swallowing aids are important to avoid administration risks. Swallowing SODFs can be easier if learned by techniques. Liquid and food are helpful as vehicles, and several of these have been listed. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: By optimizing the contributing factors of administering oral pharmacotherapy, the nurse can use appropriate practices to improve patient safety. Additionally, knowing and establishing the administration aspects are reasonable steps for standardizing care for patients with swallowing oral dosage form difficulties. IMPACT: This study addressed administering SODFs to adult patients with swallowing difficulties. The administration of SODFs to adult patients with swallowing difficulties can be optimized if only one oral dosage form at a time is administrated and if patient postural adjustments, swallowing techniques and swallowing aids are used. This investigation will impact the care of patients with swallowing difficulties. REPORTING METHOD: The authors declare they adhered to the relevant EQUATOR guidelines and report following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Statement. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Solid Oral Dosage Forms Use in Adults with Neurological Disorders and Swallowing Difficulties: A Scoping Review.

Swallowing difficulties affects the deglutition of solid oral dosage forms (SODFs) and it is a common problem among neurological disorders. Interventions may improve the use of SODFs in healthcare settings. The aim of this study was to map the available research about the interventions aiming the effective and safe use of SODFs in adults with neurological disorders and swallowing difficulties and to identify potential literature gaps in this scientific field. A scoping review was carried out based on Joanna Briggs Institute guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, in PubMed, Scopus, and SciELO databases (March 2021). Peer-reviewed observational studies assessed the effectiveness and safety of SODFs in adults with neurological disorders and swallowing difficulties in the healthcare organizations setting were included. 11 studies were included (three case reports, two mixed-methods intervention studies, and six analytic studies). The frequency of women ranged from 49 to 67%, and the age from 57 to 91 years. Most studies (n = 7) included elderly patients, Parkinson (n = 6) and dementia (n = 3). Medication review was the most frequently reported intervention, 35% (9/26). In most studies, interventions were targeted to patients during hospitalization (n = 7) and performed by physicians (n = 8). At least 20 different outcomes were evaluated in the studies. Implementing specific protocols for using SODFs aimed at the swallowing difficulties of this population is not a common practice. Additional studies on interventions aimed at optimizing SODFs are needed to support the safety and efficacy of oral therapy in this patient group.

Pharmaceutical interventions in medications prescribed for administration via enteral tubes in a teaching hospital / Intervenções farmacêuticas em medicamentos prescritos para administração via sondas enterais em hospital universitário / Intervenciones farmacéuticas en medicamientos prescritos para administración vía sondas enterales en un hospital universitario

Abstract Objective: to analyze the impact of guidelines regarding errors in medications prescribed for administration through enteral tubes. Method: quantitative study, in three phases, undertaken in internal medicine, neurology and an intensive care unit in a general teaching hospital. In Phase 1, the following was undertaken: a protocol for dilution and unit-dose repackaging and administration for 294 medications via enteral tubes; a decision flowchart; operational-standard procedures for dilution and unit-dose repackaging of oral pharmaceutical forms and for administration of medications through enteral tubes. In phase 2, errors in 872 medications prescribed through enteral tubes, in 293 prescriptions for patients receiving inpatient treatment between March and June, were investigated. This was followed by training of the teams in relation to the guidelines established. In Phase 3, pharmaceutical errors and interventions in 945 medications prescribed through enteral tubes, in 292 prescriptions of patients receiving inpatient treatment between August and September, were investigated prospectively. The data collected, in a structured questionnaire, were compiled in the Microsoft Office Excel(r) program, and frequencies were calculated. Results: 786 errors were observed, 63.9% (502) in Phase 2, and 36.1% (284) in Phase 3. In Phase 3, a reduction was ascertained in the frequency of prescription of medications delivered via enteral tubes, medications which were contraindicated, and those for which information was not available. Conclusion: guidelines and pharmaceutical interventions were determined in the prevention of errors involving medications delivered through enteral tubes.

Resumo Objetivo: analisar o impacto de diretrizes sobre erros em medicamentos prescritos para administração via sondas enterais. Método: estudo quantitativo, em três fases, realizado em clínica médica, neurologia e unidade de terapia intensiva de hospital geral universitário. Na Fase 1 elaborou-se: protocolo de diluição, unitarização - transformação e administração para 294 medicamentos via sondas enterais; fluxograma decisório; procedimentos operacionais-padrão de diluição e unitarização de formas farmacêuticas orais e de administração de medicamentos via sondas enterais. Na Fase 2 investigou-se, retrospectivamente, erros em 872 medicamentos prescritos via sondas enterais, em 293 prescrições de pacientes internados de março a junho. Seguiu-se capacitação das equipes sobre diretrizes estabelecidas. Na Fase 3 investigou-se, prospectivamente, erros e intervenções farmacêuticas em 945 medicamentos prescritos via sondas enterais, em 292 prescrições de pacientes internados de agosto a setembro. Dados coletados, em formulário estruturado, foram compilados no programa Microsoft Office Excel(r) e calculadas as frequências. Resultados: foram observados 786 erros, 63,9% (502) na Fase 2 e 36,1% (284) na Fase 3. Na Fase 3 verificou-se redução na frequência de prescrição de medicamentos, via sondas enterais, contraindicados e sem informações disponíveis. Conclusão: diretrizes e intervenções farmacêuticas foram determinantes na prevenção dos erros de medicamentos via sondas enterais.

Resumen Objetivo: analizar el impacto de directrices sobre errores en medicamentos prescritos para administración vía sondas enterales. Método: estudio cuantitativo, en tres fases, realizado en una clínica médica-neurología y en unidad de terapia intensiva de un hospital general universitario. En la Fase 1 se elaboró: protocolo de dilución, reenvasado - transformación y administración para 294 medicamentos vía sondas enterales; diagrama de flujo de decisión; procedimientos operacionales estándar de dilución y reenvasado - transformación de formas farmacéuticas orales y de administración de medicamentos vía sondas enterales. En la Fase 2 se investigó, retrospectivamente, errores en 872 medicamentos prescritos vía sondas enterales, en 293 prescripciones de pacientes internados de marzo a junio. La continuación, capacitación de los equipos sobre directrices establecidas. En la Fase 3 se investigó, prospectivamente, errores e intervenciones farmacéuticas en 945 medicamentos prescritos vía sondas enterales, en 292 prescripciones de pacientes internados de agosto a septiembre. Datos fueron colectados en un formulario estructurado, compilados en el programa Microsoft Office Excel(r) y se calcularon las frecuencias. Resultados: se observaron 786 errores, 63,9% (502) en la Fase 2 y 36,1% (284) en la Fase 3. En la Fase 3 se verificó una reducción en la frecuencia de prescripción de medicamentos, vía sondas enterales, contraindicados y sin informaciones disponibles. Conclusión: las directrices e intervenciones farmacéuticas fueron determinantes en la prevención de los errores de medicamentos vía sondas enterales.

Risk assessment of patient falls while taking medications ordered in a teaching hospital.

OBJECTIVE: to stratify prescribed medication in a fall risk scale, identifying subgroups of drugs and inpatient units with higher risk of falls. METHOD: retrospective study on prescription order forms given by medical clinic, surgical clinic, and general intensive care unit. Risk factors under consideration: 1) orthostatic hypotension; 2) arterial hypotension; 3) arterial hypertension; 4) bradycardia; 5) psychomotor agitation; 6) mental confusion; 7) dizziness; 8) drowsiness/sedation; 9) reduced eyesight; 10) seizures; 11) atonia/dystonia/muscle weakness; 12) hypoglycemia; 13) urgent urination and 14) urgent defecation/diarrhea. Risk levels adopted: 0: 0 factor; I: 1-2 factors; II: 3-5 factors; III: 6-9 factors; IV: 10-14 factors. RESULTS: 3893 drugs were analyzed and stratified in levels: 0 22.7%; I 33.5%; II 28%; III 15.1%; IV 0.7%. Levels III and IV more often refer to drugs for stomach acid disorders, 22.6%, and psycholeptics, 100%. CONCLUSION: knowing the risk factors associated with medication may help prevent and reduce falls, especially when therapeutic regimens cannot be modified.

Avaliação dos riscos de queda de pacientes em uso de medicamentos prescritos em hospital universitário / Evaluación de los riesgos de caída de pacientes en el uso de medicamentos prescritos en hospital universitario / Risk assessment of patient falls while taking medications ordered in a teaching hospital

RESUMO Objetivo: estratificar medicamentos prescritos em escala de risco de queda, identificando subgrupos de medicamentos e unidades de internação com maior risco de queda. Método: estudo retrospectivo em prescrições de clínica médica, clínica cirúrgica, unidade de terapia intensiva geral. Fatores de risco considerados: 1) hipotensão ortostática; 2) hipotensão arterial; 3) hipertensão arterial; 4) bradicardia; 5) agitação psicomotora; 6) confusão mental; 7) tontura; 8) sonolência/sedação; 9) diminuição da visão; 10) convulsões; 11) atonia/distonia/fraqueza muscular; 12) hipoglicemia; 13) urgência micção e 14) urgência defecação/diarreia. Estabeleceu-se graus de risco: 0: 0 fator; I: 1-2 fatores; II: 3-5 fatores; III: 6-9 fatores e IV: 10-14 fatores. Resultados: foram analisados 3893 medicamentos, estratificados como graus: 0 22,7%; I 33,5%; II 28%; III 15,1%; IV 0,7%. Os graus III e IV referiram-se mais frequentemente a fármacos para distúrbios da acidez gástrica, 22,6%, e psicolépticos, 100%. Conclusão: conhecer fatores de risco associados aos medicamentos pode contribuir para prevenção e diminuição de quedas, sobretudo quando regimes terapêuticos não podem ser modificados. .

RESUMEN Objetivo: estratificar medicamentos prescriptos en escala de riesgo propuesta, identificando subgrupos de drogas y unidades de hospitalización con mayor riesgo de caídas. Método: estudio retrospectivo en prescripciones de clínica médica, clínica quirúrgica, unidad de cuidados intensivos. Factores de riesgo considerados: 1) hipotensión postural; 2) hipotensión arterial; 3) hipertensión arterial; 4) bradicardia; 5) agitación psicomotora; 6) confusión mental; 7) mareos; 8) somnolencia/sedación; 9) convulsiones; 10) disminución visión; 11) atonía/distonía/debilidad muscular; 12) hipoglucemia; 13) urgencia orinar; 14) urgencia defecar/diarrea. Grados de riesgo establecidos: 0: 0 factores; I: 1-2 factores; II: 3-5 factores; III: 6-9 factores, IV: 10-14 factores. Resultados: analizados 3893 medicamentos estratificados como grados: 0 22,7%; I 33,5%; II 28%; III 15,1%; IV 0,7%. Fueron más frecuentes para los grados III y IV: fármacos para trastornos de la acidez gástrica, 22,6%, y psicolépticos, 100%, respectivamente. Conclusión: conocer factores de riesgo asociados con la medicación puede contribuir para prevenir y reducir caídas, sobre todo cuando regímenes terapéuticos no pueden ser cambiados. .

ABSTRACT Objective: to stratify prescribed medication in a fall risk scale, identifying subgroups of drugs and inpatient units with higher risk of falls. Method: retrospective study on prescription order forms given by medical clinic, surgical clinic, and general intensive care unit. Risk factors under consideration: 1) orthostatic hypotension; 2) arterial hypotension; 3) arterial hypertension; 4) bradycardia; 5) psychomotor agitation; 6) mental confusion; 7) dizziness; 8) drowsiness/sedation; 9) reduced eyesight; 10) seizures; 11) atonia/dystonia/muscle weakness; 12) hypoglycemia; 13) urgent urination and 14) urgent defecation/diarrhea. Risk levels adopted: 0: 0 factor; I: 1-2 factors; II: 3-5 factors; III: 6-9 factors; IV: 10-14 factors. Results: 3893 drugs were analyzed and stratifi ed in levels: 0 22.7%; I 33.5%; II 28%; III 15.1%; IV 0.7%. Levels III and IV more often refer to drugs for stomach acid disorders, 22.6%, and psycholeptics, 100%. Conclusion: knowing the risk factors associated with medication may help prevent and reduce falls, especially when therapeutic regimens cannot be modifi ed. .