Crushing Medications: Requires Doctor's Orders

Title 22, Section 87465 (a)(6)(D):  "Incidental Medical and Dental Care Services," provides the state's requirements and guidance for crushing medications.  

There are only two reasons, per the regulations, when a medication can be crushed:  to enhance swallowing, or to disguise the taste.   Crushing a medication cannot be done to trick or deceive a resident into taking a medication s/he would otherwise refuse. 

Prior to any crushing of a resident's medications,  the facility administrator must consult with a pharmacist and the physician.  The consultation can be done verbally or in writing, but either way, must be documented; documentation becomes part of the resident's permanent medical record.  Documentation required includes:

a.  dose

b.  instructions when and how often the medication will be given.

c.  the names of the doctor and pharmacist, along with their business names and the date of the conversation

d.  a written statement that the medication can 'be safely crushed without losing potency,"  

e.  identification of the foods and liquids the crushed medications can be mixed with, and

f.  instructions for crushing and mixing medication. 

g.  a consent form giving authorization for the medication to be crushed signed by either: 

i.  The resident if s/he isn't conserved.  If the resident cannot sign his name, his mark must be witnessed by a person who is not the license nor an employee of the facility. 

ii.  The resident's conservator when the conservator has authority to make decisions on this issue. 

Many medications (i.e. slow release, extended release, enteric coated, gels) cannot be crushed, and may be very dangerous for the resident if they are:  the resident will receive too much of the dose too quickly.   For that reason, a doctor’s order is needed before any medication can be crushed, then dosed, to a resident.   

The facility cannot unilaterally decide to crush and dose a medication for your resident.  If you are uncertain about why your resident is receiving crushed medications, ask to see the documentation specified above by Title 22.  If the facility doesn't have the documentation, file a complaint with CCL. 

Medications, after crushing, can be mixed with a small amount of applesauce, yogurt, pudding or mashed potatoes –  the doctor or the pharmacist will give guidance on an appropriate carrier at the time the crushed-medication order is received.

Caution 1:  Crushing medications cannot be used as a method to trick or deceive the resident into taking a drug or medication that he has, or would otherwise refuse to take.

Caution 2:  Crushing medications without a doctor's order could lead to adverse effects on the resident - including death.  

If your resident has swallowing difficulties,  notify the resident's doctor at the time the medication is being prescribed, as many medications are available in alternate forms (patches, suppositories, liquids, inhalers).  

Notes in italics represent the views and/or experience of CARR regarding this topic and/or regulation.