Enteral Administration Reference

Introduction

Once you start working in hospital, you will soon realize that patients at workplace are often not the typical cases that you encounter in university examination, but more complicated.

• Some of them may have swallowing difficulty or are on enteral feeding tube.

In general, the main source of information will be product leaflet under method of administration or journals and some considerations in making an informed decision (i.e. some medications should not be altered due to some reasons).

• There are few references that specifically provide a quick answer on whether a drug can be administered by enteral feeding tube or not.

Don't Rush to Crush

My personal preference of all would be Don't Rush to Crush by Advanced Pharmacy Australia (AdPha) [formerly known as SHPA (Society of Hospital Pharmacists of Australia)]. The latest 4th edition includes more than 580 oral medications, as well as

• New information about the thickness of oral liquid medicines and their suitability for people with swallowing difficulties.
• A new section about gastrointestinal dysfunction that provides guidance for giving medicines to people who have undergone gastrointestinal surgery, or who have altered gastrointestinal function.

It provides a quick list of options in what to do for people with enteral feeding tubes, people with swallowing difficulties and doses less than a whole tablet.

Handbook of Drug Administration via Enteral Feeding Tubes

Next, I would recommend Handbook of Drug Administration via Enteral Feeding Tubes by Pharmaceutical Press (a UK publisher). On top of providing recommendation for 404 drug monographs, it also addresses the technical aspects of enteral feeding tubes, such as types of enteral feeding tube and maintaining patency of enteral feeding tubes. For your interest, this is the only reference of the three in which the PDF softcopy can be easily found over the internet.

The Guidebook on Enteral Medication Administration

The final recommendation would be The Guidebook on Enteral Medication Administration by American Society for Parenteral and Enteral Nutrition. This is the most newly added reference in this list, and it covers the least number of drugs (only 169 individual drug monographs). Based on the official website, highlights covered in this book include:

• Enteral access devices
• Drug interactions with nutrition
• Foundational principles of drug solubility and bioavailability
• Up-to-date recommendations for drug preparation and administration

Online Websites

The NEWT guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties and the website swallowingdifficulties have information on crushing safety and potential alternative routes of administration for many medications.