Pascal Bergeron
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I received a question the other day which asked:

If it was ok to crush medications and place the crushed medications into applesauce to be given to a resident?

Let’s break the question down…..


1. Can medications be crushed?

Yes, BUT you must have a doctor’s order stating so.


2. Who can crush medications?

A licensed professional (LPN,RN)

a non-licensed professional(Med tech,CNA) can as long as they have their required Assistance with medications training up to date.

Regulation

Section 429.256(4), F.S., “assistance with self-administration of medication” by an unlicensed person does NOT include or shall NOT be allowed for: (a) Mixing, compounding, converting, or calculating medication doses, EXCEPT
for measuring a prescribed amount of liquid medication or breaking a scored tablet or crushing a tablet as prescribed;

 

Next question

1.  Is putting crushed medication in applesauce allowed?

Answer: It Depends

 

First, we need to evaluate why is the medication being put into the applesauce?

 

In most cases the reason I hear is….

The resident has dementia and won’t take the pills or spits them out.

If that is the reason the answer to “Can you put the crushed medications in the applesauce of this resident with dementia” would be only a licensed professional (RN LPN) Can put the crushed medications in the applesauce.

Your unlicensed staff (CNA,HHA,Med Tech, Administrator) CAN NOT place the crushed medications in this resident’s applesauce.

 

Why and Why NOT?

Whenever you have a resident with dementia,Alzheimer’s or cognitive impairment your unlicensed staff CANNOT follow the proper medication assistance regulations and therefore cannot assist this resident with medications period. Only a licensed professional can assist these residents.

Why is that?

Let’s look at the regulation


Section 429.256(3), F.S., “assistance with self-administration of medication” by an unlicensed person includes:

(a) Taking the medication, in its previously dispensed, properly labeled container, including an insulin syringe that is prefilled with the proper dosage by a pharmacist and an insulin pen that is pre filled by the manufacturer, from where it is stored, and bringing it to the resident;
(b) In the presence of the resident, reading the label, opening the container, removing a prescribed amount of medication from the container, and closing the container;
(c) Placing an oral dosage in the resident’s hand or placing the dosage in another container and helping the resident by lifting the container to his or her mouth;
(d) Applying topical medications;
(e) Returning the medication container to proper storage;
(f) Keeping a record of when a resident receives assistance with self-administration
of medication using a Medication Observation Record (MOR);
(g) Assisting with the use of a nebulizer, including removing the cap of a nebulizer,
(3) ASSISTANCE WITH SELF-ADMINISTRATION.
(a) Any unlicensed person providing assistance with self-administration of medication must be 18 years of age or older, trained to assist with self-administered medication pursuant to the training requirements of Rule 58A-5.0191, F.A.C., and must be available to assist residents with self-administered medications in accordance with procedures described in Section 429.256, F.S., and this Rule Chapter.

(b) In addition to the specifications of Section 429.256(3), F.S., assistance with self-administration of medication includes reading the medication label aloud and verbally prompting a resident to take medications as prescribed.
(c) In order to facilitate assistance with self-administration, trained staff may prepare and make available such items as water, juice, cups, and spoons. Trained staff may also return unused doses to the medication container. Medication, which appears to have been contaminated, must not be returned to the container.
(d) Trained staff must observe the resident take the medication.Any concerns about the resident’s reaction to the medication or suspected noncompliance must be reported to the resident’s health care provider and documented in the resident’s record.
(e) When a resident who receives assistance with medication is away from the facility and from facility staff, the following options are available to enable the resident to take medication as prescribed:
1. The healthcare provider may prescribe a medication schedule that coincides with the resident’s presence in the facility;
2. The medication container may be given to the resident,a friend,or family member upon leaving the facility, with this fact noted in the resident’s medication record;

  1. The medication may be transferred to a pill organizer pursuant to the requirements of subsection (2), and given to the resident, a friend, or family member upon leaving the facility, with this fact noted in the resident’s medication record; or
    4. Medications may be separately prescribed and dispensed in an easier to use form, such as unit dose packaging.
    (f)Assistance with self-administration of medication does not include the activities detailed in Section 429.256(4), F.S.
    1.As used in Section 429.256(4)(g), F.S., the term “competent resident” means that the resident is cognizant of when a medication is required and understands the purpose for taking the medication.
    2.As used in Section 429.256(4)(h), F.S., the terms “judgment” and “discretion” mean interpreting vital signs and evaluating or assessing a resident’s condition when assisting with self-administration of medication.
    (g)All trained staff must adhere to the facility’s infection control policy and procedures

 

Clarified Answer

Unlicensed staff are required to read the medication label to the resident. Therefore the resident must be competent and able to understand what is being read to them.

If the resident has Alzheimer ’s, Dementia or cognitive impairment the resident is unable to understand what the unlicensed staff is reading to them then they can not understand what is being given to them.

If the resident does not understand what you are giving them then Only a Licensed Professional can dispense the medications to that resident.

Which means if the crushed medications are being placed in the applesauce because that is the only way your resident with dementia will take the medications then only a licensed professional can assist that resident.

If you have a resident that has trouble swallowing and is competent and understands when the medication label is read to them and understands that the crushed meds are in the applesauce then your unlicensed staff may place the crushed medications into the applesauce and give it to the resident.

 

Summary

To legally crush  and dispense medications the following must be performed:

Need to have a Dr’s order to crush medications

Unlicensed and Licensed staff can crush medications.

Unlicensed staff can only assist competent residents with medications.

Licensed professionals can crush and dispense to all residents.

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