Dementia, Dysphagia and Avoiding Disaster: Considerations of Altered Medication Administration

Session Year: 
Demetra Elizabeth Antimisiaris, PharmD, CGP Rangaraj Gopalraj, MD, PhD

The University of Louisville Department of Family Medicine and Geriatrics provides care and medical directors for multiple skilled facilities, intermediate care facilities, assisted living facilities, and personal care residents. One of our missions, in addition to education, is fostering a heightened level of quality assurance in our facilities. This session will review, educate, and discuss the important but not often emphasized topic of altered solid oral medication dosage forms in the LTC setting. This is a topic which University of Louisville Geriatrics have had a special interest in for some years, inspired by an extraordinary case study (a patient we had) who was a short-term nursing home resident who literally came weeks from death due to just one crushed medication (of the two medications) she was receiving. Once the problem was discovered, her recovery and discharge from our facility was remarkable. This led us to conduct a four facility quality survey which yielded startling results. In addition to the presentation of our own experience and studies of altered dosage forms, the session will review the current literature, biopharmaceutics principles, common situations necessitating consideration of altered dosage forms (change in food texture which is a tip that medications are not being swallowed whole, NG tubes which has other considerations, i.e. warfarin dose sticks to tube), barriers and motives for medication alteration, IDT coordination failures, and what to do, including model program ideas. This session will include active learning exercises to stimulate shared discussion between attendees.

1.5 Clinical