New Consensus Guidelines Published

26th October 2006

A new consensus guideline issued today on the medication management of adults with swallowing difficulties recommends that healthcare professionals should always ask if a patient has difficulty swallowing medication [1]. This advice comes in light of evidence that almost 60% of older people have experienced problems taking solid medicines [2]. The guideline highlights that many physicians are unaware of the scale of the problem, and fail to take even simple steps to check that a patient is actually able to swallow the medicine prescribed. Many patients continue to open capsules or crush tablets to make them easier to swallow - unaware that this could have serious consequences.

The guideline recommends that improved communication between healthcare providers and patients is essential to avoid complications for the patient and the risk of litigation for the prescriber. It is estimated that 75 million prescriptions a year are associated with adverse drug reactions and that almost 60% of these are avoidable [3]. Asking one simple question, 'Do you have difficulty swallowing your medicine?' could go a long way towards reducing this unacceptably high number of adverse events.

If improved patient care alone is not a sufficiently motivating factor, the guideline also reminds healthcare professionals that they could be legally liable if a patient has an adverse reaction as a result of crushing a non-crushable tablet.

Richard Griffith (Lecturer in Healthcare Law, University of Wales) who helped formulate the guideline, commented: 'A healthcare professional who advises that a tablet is crushed or a capsule opened to assist with swallowing difficulties should proceed with caution. Any resulting harm could render the person legally liable due to negligence. Improved communication between prescriber and patient could significantly reduce these problems, and dramatically improve patient care.'

David Wright, Senior Lecturer in Pharmacy at the University of East Anglia, and Chair of this working party guideline said: 'Many drugs are now given in a slow release format. Crushing or opening means that the drug is released quicker than it is designed to be, and this can cause side effects. We know that many older people have problems swallowing their medications and dysphagia/medication management guidelines are long overdue.'

Please click here to download a PDF of the guideline.

The guideline summary has been published in the latest edition of Guidelines and can be viewed at www.eguidelines.co.uk/dysphagia

To obtain a hard copy of the summary or full guideline, please contact Connectmedical at:
The Chapel, Park View Road, Berkhamsted, Herts, HP4 3EY; Tel: 01442 876100; Fax: 01442 877100; Email: connectmedical@mgp.ltd.uk

This working party guideline was drafted by:

David Wright, Senior Lecturer in Pharmacy, University of East Anglia (UEA) (Chair)
Nigel Chapman, HM Coroner for Nottinghamshire
Mathias Foundling-Miah, Consultant Pharmacist and Barrister at Law
Ralph Greenwall, Senior Pharmacist, Bradford PCT
Richard Griffith, Lecturer in Healthcare Law, University of Wales
Anne Guyon, Speech and Language Therapist, UEA
Honor Merriman, GP and CPD tutor, Oxford

With additional input from:

Ian Costello, Chief Pharmacist, St George's Hospital, London
Mark Greener, Pharmacologist, Medical Writer
John Hindle, Consultant Geriatrician, Llandudno Hospital, Llandudno
Stephen Tomlin, Principal Paediatric Pharmacist at Guy's and St Thomas' Hospital, London

References

1. Wright D, Chapman N, Foundling-Miah M et al. Consensus guideline on the medication management of adults with   swallowing difficulties. In: Foord-Kelcey G, editor. Guidelines - summarising clinical guidelines for primary care. 30th   ed. Berkhamsted: Medendium Group Publishing Ltd; October 2006. p. 373 - 376
2. Strachan I and Greener M. Medication-related swallowing difficulties may be more common than we realise.    Pharmacy in Practice 2005; 15 (10): 411-414.
3. Greener M. Wasted medicines and avoidable adverse events: a multibillion pound problem. Journal of Medical    Economics 2006; 9: 27-44. See http://www.pjbpubs.com/medical_economics/index.htm