Date of Award

Winter 1-4-2019

Document Type

Dissertation

Degree Name

PharmD

Department

Department of Pharmacy Practice

First Advisor

Dr. M Surulivel Rajan

Second Advisor

Dr. Shivashankar KN

Abstract

Background: Administration of drugs via the nasogastric tube (NGT) has become very common in ICU patients. Many drug formulations are administered in the crushed form through the tube and this procedure is increasingly done by the nurses. Although crushing of solid dosage forms permits the ease of administration, there are several dosage forms that should not be broken or crushed as it can result in various problems like decreased or increased bioavailability, drug interactions or interaction with the tube itself. Objectives: To assess the problems encountered when medications are being administered by nasogastric tube in a tertiary care hospital and to develop a guide/chart for medication administration by the NGT and to conduct a questionnaire survey among nurse practitioners to assess their knowledge on drug administration through NGT. Methods: A prospective observational study was conducted in medicine ICU patients who were on nasogastric tube. Patient medical records were checked for the date of NGT intubation and the medications administered after the intubation. The drugs administered were checked for appropriateness of the dosage form. A questionnaire study was conducted among the nurses to assess their knowledge regarding the administration of drugs through the NGT. Data entry and statistical analysis were done using the software version of SPSS 20. Results: Out of a total of 261 drugs administered to the patients with nasogastric tube, 68.1% of the medications were found being administered through the tube and the remaining 31.8% of the drugs were administered through other routes. Among the 178 drugs administered through the tube, it was found that 48.87% of the drugs were being administered inappropriately, that is, drugs of the dosage forms that must not be crushed were found being crushed and administered and 51.12% drugs were administered appropriately. The questionnaire survey had a response rate of 62.5%. While 90% of the nurses agreed to assess the dosage form before administering it through the NGT, only 20% were aware that SR/CR tablets should not be crushed and 57.5% were aware that enteric coated drugs must not be crushed before administration. A total of 80% of nurses agreed to pursue continuous education regarding appropriate administration of drugs through the NGT. Conclusion: Potential problems associated with the administration of inappropriate dosage form of drugs through the NGT are great many. It can lead to drug interactions, increased or decreased bioavailability or adverse reactions which may be fatal to patients. Nurses have to be vigilant about the dosage forms they are administering. An increase in awareness regarding medication prescription among clinicians is of utmost importance. Clinical pharmacists can be of great assistance with regards to prescription monitoring, thus helping in reducing the clinicians as well as the nurse’s burden.

Download

Share

COinS