Nurses have long been aware of challenges in administering medications through an enteral feeding tube, including the potential for tube clogging; interactions between the drug and the feeding formula; changes in drug onset, duration, and efficacy; and the unsuitability of prescribed medications for feeding tube administration. Failure to consider these potential problems can lead to medication errors or adverse drug effects.
The Institute for Safe Medication Practices (ISMP) attributes errors in medication administration via feeding tube to the lack of "readily accessible information, gaps in training/experience, unknown feeding tube status, incorrect or inappropriate route or tube size, improper preparation, and wrong administration techniques." The type and size of the tube and where the distal end opens (stomach, duodenum, or jejunum) are important. Not all drug preparations are appropriate for the size and diameter of the enteral feeding tube, and variations in acidity in different parts of the gastrointestinal tract can alter a drug's absorption or efficacy or the likelihood of adverse effects.
Nurses may be familiar with the ISMP's Do Not Crush List that was designed to identify which solid oral drugs cannot be administered via a feeding tube. The ISMP recently highlighted new research on this list by Uttaro and colleagues that was designed to simplify the list, remove any unnecessary restrictions, and provide conditional recommendations if needed.1 Nurses who work in institutions that have a Do Not Crush List can compare theirs to this updated list.1 Nurses can also be active on interdisciplinary organizational committees and review their institution's policies on drug administration via feeding tubes to confirm that these policies are up to date.
The ISMP offers the following suggestions to prevent medication errors related to administering medications via a feeding tube:
* All medication orders should specify that the drug is to be given via an enteral feeding tube not the oral route. Electronic health records should provide a prompt asking if the drug is to be given by feeding tube and if yes, then size and diameter of the tube should be entered before the order can be processed.
* To prevent interactions, two or more drugs should not be mixed together. Each drug should be prepared separately in an ENFit syringe system, which is designed for an enteral feeding tube and cannot connect to other types of ports (such as a vascular port). Crushed solid drugs should be mixed with purified water; liquid forms should be used if available.
* The tube should be flushed after each drug.
* Medication administration should not be combined with tube feeding. Continuous feeds should be stopped, and the tube flushed before and after medication administration. The drug's labeling should be checked for special directions, as some drugs (such as phenytoin) require a delay before restarting continuous tube feeding.
To read the full online article from the ISMP on enteral tube safety, see http://www.ismp.org/nursing/medication-safety-alert-december-2022?check_logged_i. Please note, parts of this website require a subscription.
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