Convalescent Multidisciplinary Collaboration Lab Vol. 2: Wait, 'furifuri' (shaking) for simple suspension is a no-go?
It's been a while, but here is the 2nd Multidisciplinary Collaboration Lab🌸✨
▼Click here for the 1st session.
▼Click here for Irodori-chan's article on the 1st session.
This time, I've compiled into an article all the questions about 'simple suspension' that have come up in various clinical settings, starting with a question from Irodori no Uta-san😊
I'm curious, but I can't really ask...
Is this the right way to do it??
It's kind of embarrassing to ask at this point...
If you are reading this and feeling that way,
this article might be a little helpful to you🌈✨
Irodori no Uta-san writes from a nurse's perspective.
And of course, I, HONO, write from a pharmacist's perspective.
Two articles on the same topic, but from slightly different angles📚
I would be very happy if you could take a look at both😊
Now, let's go🌈
One day on the ward
After confirming that the tube feeding for a patient had finished, Irodori-chan was preparing the post-meal oral medications.
At our hospital, we use something called a 'suspension bottle.'
Into that bottle, she puts...
the prescribed medications.
She puts in the powdered medicine and the tablets just as they are.
Adds hot water.
Closes the lid.
And, shake!!!
Irodori🐦
'The tablets just won't dissolve. I'm so busy, and they're still lumpy'
HONO didn't miss that!!
HONO💊
'Hey!! What are you doing, Irodori-chan!!'
Irodori🐦
"Huh? Simple suspension?"
HONO💊
"Stop, stop!! That's not right!!"
HONO💊
"Simple suspension isn't a 'constant shaking competition,' it's more like a ritual where you wait for it to quietly disintegrate, then give it a quick shake to finish it off!"
Irodori🐦
"What did you say!?!"
First, let's review simple suspension.
Some patients who have difficulty eating by mouth have tubes inserted into their nose or stomach to receive liquid nutrition.
In those cases, since it is difficult for them to take medication by mouth, it is administered through the tube.
Simple suspension is a method of administering medication through a tube by disintegrating and suspending it in approximately 55°C (131°F) water.
*While simple suspension is also used for oral administration, this article focuses on cases of tube feeding.
it means 'putting medicine in hot water to make it disintegrate.'
Irodori🐦️
"Since simple suspension ends up dissolving in water, I've always wondered if the result is the same as crushing it... HONO-chan, what's the difference?"
HONO💊
"Irodori-chan, you've noticed something good!! Actually, simple suspension doesn't mean you're dissolving it."
as long as it disintegrates, it's fine!!
The reality of the ward and the 'no time' problem
From here on, Irodori 🐦 will tell you a little about the reality of nurses.
'Simple suspension'
I know it as knowledge.
However, knowing it and being able to practice it that way every time during work are two different things.
Nurses on the front lines are always juggling multiple tasks.
🍚 Mealtime is always a war 💦
Preparing patient meals in the dining room.
Serving and clearing trays.
Assisting with meals.
Watching over them to ensure they are eating safely.
Distributing medication.
Confirming oral intake.
Flowing from there,
assisting with brushing teeth and washing faces.
Guiding and assisting with the toilet.
Escorting the patient back to their room,
having them lie down in bed and encouraging them to rest.
Ensuring the area around the bed is safe before leaving the room.
In about 40 minutes, we have to get all this work done.
And tube feeding is handled on a different workflow from the dining room tasks.
In the midst of that.
Irodori🐦️
“Watching for the end of the nutrition feed,
preparing 55°C water,
waiting 5 to 10 minutes,
and checking the condition before injecting...
It doesn't go that smoothly! 😫
That's why I end up crushing them or shaking them up! (ﾉД`) *sob*
HONO💊
“Shaking it like crazy... is a no-go. 😆
At first, just send it your 'please dissolve quickly'
thoughts. 😆
You can shake it after about 5 minutes, so it's okay. 😊”
Beware of mysterious cocktails 😳
Irodori🐦️
“Powdered medicine and tablets, all into the same bottle. This is the ultimate time-saver!”
HONO💊
“Wait. How many types did you put in that bottle?”
Irodori🐦️
“Uh... a variety?”
HONO💊
“That’s not simple suspension; that’s an unidentified drug cocktail. 😑”
Irodori🐦️
“Oh dear... 😫”
Even though you administered it, the medicine doesn't work...
To avoid things like that, let's stop making mysterious cocktails!
From here on, HONO will explain. 🌸
Let's talk a bit more about what that 'mysterious cocktail' is doing inside the bottle using some imagery.
When you put multiple types of medicine together,
the drugs can fight or stick to each otherand their properties can change. 💡
As a result, these things are more likely to happen. 🤔
At the bottom of the cup,white, mud-like sedimentaccumulates.
It turns into ajelly-like, wobbly geland won't flow no matter how long you wait.
It becomes 'sludgy' or 'sticky' andeasily sticks and clogsinside the narrow feeding tube.
When the tube gets clogged, it needs to be replaced or flushed... which means more painful and distressing procedures for the patient. 😔
Even if you intend to 'save time by combining everything,' it can lead to tube trouble or disrupted drug efficacy later, which actually increases time and effort as well 💦
And, depending on the case, you might not get the intended effect of the medication you are taking for treatment—that is the main point I want to convey today 🌈
Tell me! HONO-sensei! Corner
In preparing this article on simple suspension, Irodori and HONO-chan had several meetings beforehand.
During those, one interesting topic after another came up.
I really want to include everything, but
Irodori is currently a bit physically exhausted 🐦.
However, thinking that HONO-chan's answers are very educational... I decided to write the rest in a Q&A format.
🐦 'I heard that if a tablet has a score line, it's okay to crush it'... Is that true?
HONO💊
Score lines are made on the premise that you will 'snap it into two pieces along the line.'
There are some drugs where breaking them into smaller pieces than the line changes how they work and becomes dangerous.
Instead of thinking 'it has a score line so it's okay to crush it,'
it might be safer to think 'it has a score line so half might be okay,' but 'always confirm crushing with a pharmacist' 😌
Having a score line = okay to crush
is not true! This is really important, so please be sure to consult with a pharmacist 😆
🐦 'I've been removing capsules, but is it better not to?'
HONO💊
For some drugs, that is the correct approach.
Capsules do eventually dissolve in your stomach, right?
While there are some drugs where 'capsule removal is allowed,' if you remove the capsule on your own judgment, the way it works or its side effects could change drastically, which is dangerous!!
So, instead of thinking 'if it dissolves anyway, the capsule isn't needed,'
you can rest assured if you always confirm with a pharmacist whether 'this drug is the type where the capsule itself has a purpose' before removing it.
I totally understand the feeling of wanting to give it without the capsule! But since it can sometimes cause tube blockage or lead to a sudden spike in blood concentration, please always check with a pharmacist first 🌸
🐦 'What should I do about soft capsules?'
HONO💊
For soft capsules, first try putting them 'capsule and all' into 55°C (131°F) water and wait for about 10 minutes.
The shell will soften, and the contents will ooze out.
In that state, the basic procedure is to draw only the contents into a syringe without drawing up the shell, and then flush it through the tube.
Only if it absolutely won't dissolve, please consult a pharmacist to confirm 'if this drug is the type that is okay to remove from the capsule and use for simple suspension' before removing the contents to use it.
Basically, capsules are designed to dissolve at around 50°C. So, in principle, they are fine as they are👌 However, I think it's reassuring to decide within your own facility when to 'consult someone if this happens'😆
I've written in detail about mysterious cocktails in this article, so please take a look if you have the time🌸
It is important that administered medication works safely and effectively, isn't it?
This time, I presented the method known as the simple suspension method
in a way that resolves questions from the field.
I've explained it in simple terms, so if you feel like 'I want to learn this thoroughly!!', please check out the reference book link I've posted🌸
(I don't earn a single yen from it, but it's a very good book😆)
And also, this✨
Aokapu@Pharmacist has created a simple suspension feasibility checker!
This checker, which allows you to look things up quickly,
I believe will surely be useful for safety management as well🌸
I use it regularly myself, so everyone please go take a look✨
Multidisciplinary collaboration is truly wonderful, isn't it✨
I ended up asking Irodori-chan a lot of questions too😊
Irodori-chan!
Thank you for creating this article with me🌈
Everyone, go check out Irodori-chan's articles too😆
いいなと思ったら応援しよう！
よろしければ応援お願いします！いただいたチップはオロナミンCの購入費としてモチベーションと活力アップに使わせていただきます✨