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To crush or not to crush - medication guide for residential aged care

To crush or not to crush - medication guide for residential aged care

To develop an online resource for Residential Aged Care (RAC) facilities to help staff to safely give oral medication to residents who have difficulty swallowing tablets and capsules


  • Pharmacists often receive queries about crushing oral medicines because there is no easily accessible, accurate and reliable resource for RAC staff to refer to
  • We wanted to develop a resource to ensure that all RAC staff safely administer oral medicines, and know when to consider alternative formulations (eg syrups, suppositories, patches) if necessary

What did we find?

  • Many RAC residents that have difficulty swallowing whole tablets and capsules, have their medicines modified (crushed, halved, opened, dissolved) 
  • Whilst this practice ensures that prescribed medicines are administered, this may result in reduced effectiveness, increased toxicity, as well as concerns about safety and stability (of ingredients)

What did we do?

  1. We identified the oral medicines commonly prescribed and administered in RAC facilities
  2. For each of these medicines we identified:
    • whether they could be crushed or modified, and any specific requirements for administration
    • alternative forms available, eg liquid or a different medicine altogether
  3. This information has been published on our SafeRx website and disseminated to RAC facilities with an education bulletin about crushing oral medicines

Did we make a difference?

A referenced resource is now available to RAC staff recommending best practice for the modification and administration of oral medicines, and providing guidance about safe alternatives.


Well-received by RAC facilities

Utilised by other healthcare providers

Queries reduced to pharmacists about modifying oral medicines

Raised staff awareness about problems arising from modifying medicines

Where to from here?

  • This referenced resource is available electronically and will continue to be updated on a monthly basis to reflect changes in the PHARMAC schedule
  • Dissemination to other RAC facilities and pharmacies in other DHB areas is planned

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