Safety First Blog

Do Not Crush List

Posted by Laura Paxton on Apr 10, 2023 10:13:54 AM
Laura Paxton
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First shared in 2003, the ISMP’s (Institute for Safe Medication Practices) list of Do Not Crush Medications has been relied upon by healthcare facilities across the U.S. However, as of Nov. 17, 2022, the ISMP does not maintain or share this list on its website. 

At the time of the 2022 announcement, ISMP recommended that hospitals “maintain, update, and periodically review a list of oral dosage forms that may require alteration through evaluation of package inserts, drug manufacturer inquiries, tertiary drug information resources, and primary literature.” Hospitals had come to rely on ISMP for easy access to this updated list and now must do most of the leg work themselves. 

While crushing pills can improve ease of administration, it is imperative that clinicians follow the guidance and only crush those that are safe and in the right conditions. For instance, extended-release meds can result in the patient receiving a large dose all at once. Similarly, when delayed-release meds are crushed, the mechanism designed to protect the drug from gastric acids or prevent gastric mucosal irritation may be impaired. In other cases, crushing hazardous meds may actually be harmful to the nurse or pharmacist. In this case, the USP <800> guidance should be followed. 

Where is your “Do Not Crush List” documented within your facility? 

While the USP <800> provides guidance on the safe handling of tablets when crushing for administration, it does not require the current list of drugs on the Do Not Crush list to be explicitly documented. We believe this list should be available to nurses and clinicians at the point of care. 

Safety Information at the Point of Care Improves Outcomes

Most clinicians currently search through six or seven systems or websites (SharePoint, hospital intranet, Google, FDA Black Box warnings, etc.), taking 20 clicks or more, to get the safety information needed to care for patients and protect themselves from hazardous drug exposure. Even when these links are available in the Electronic Health Record (EHR), searching for information takes too long delating patient care and creating opportunities for med errors. 

We believed that patient outcomes could be improved and healthcare workers better protected if clinicians could reach the necessary safety information within their normal workflow. Through our product’s analytics, we were blown away to see that 90% of clinicians were more likely to use safety information if it was easily accessible within one or two clicks at the point of care. When doctors and nurses have to interrupt their workflow and leave the EHR to go to Sharepoint or another app to find it, they just won’t. 

This applies to all safety information which, of course, includes the Do Not Crush list. If that life-saving information is not accessible within one to two clicks of a mouse, chances are it is not being referenced and followed. 

Back to the original questions at hand: 

  • How is your organization now updating and maintaining your Do Not Crush list? 
  • Is it easily accessible by all who need to access this vital information? 

If you’re concerned about the accessibility of medication safety information in your organization, Rpharmy can show you a simple and effective way to make these vital, life-saving resources available at the point of care. Schedule a meeting at your convenience. 

We also invite you to check out the USP <800> resources on our Safety First Blog and sign up for our free Lunch + Learn webinar series on all things USP <800>. 

Fun fact: The Do Not Crush list was first compiled and published as The List of Oral Dosage Forms That Should Not Be Crushed by John Mitchell, PharmD, and is now maintained and updated annually by Thomas Land Publishers, the well-known medical and health sciences publishing house. 

Topics: Rhazdrugs, Policy, USP <800>, Formweb

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