Episcopal Church Home The Gardens

spoon. R2 was able to swallow and finish the medications with applesauce. At 9:09 a.m., TMA-A was asked why she crushed the capsules.

She stated it was hard to take apart capsules with gloves on, so she usually crushes them instead.

During an interview on 10/16/15 at 1:00 p.m., TMA-A stated the facility has given her education on delayed release medications.

She stated she was aware R2 had delayed release medications, and they shouldn't have been crushed or opened. TMA-A stated she could not remember what delayed release medications meant.

During an interview on 10/16/25 at 1209 p.m., licensed practical nurse (LPN)-A stated there was recent education on medication administration.

The education was about making sure dosages that are being given match the prescriber's order. LPN-A stated the physician should be called to determine if it is okay to open a delayed release capsule medication.

During an interview on 10/16/25 at 1:08 p.m., TMA-B stated he would not crush capsule medications, he would open the capsule and empty it.

TMA-B was unable to explain the purpose of delayed or extended-release medications or any concerns that would accompany crushing or opening delayed release medications.

During an interview on 10/16/25 at 1:19 p.m., registered nurse (RN)-A stated the facility provided education on delayed release medications.

Staff should check with the prescribing physician about opening a delayed release capsule.

Capsules shouldn't be crushed.

When asked about crushing delayed release medications, RN-A stated the medication effects could hit the patient quickly rather then slowly.

During an interview on 10/16/15 at 12:26 p.m., a pharmacist stated that she was concerned that the pharmacy had it documented the Divalproex Sodium was being given in tablet form and not capsule form.

The facility staff should not be crushing capsules, staff should be twisting the capsules to open them and sprinkle the powder out. If a medication was delayed or extended release and was being crushed, there could be a concern about dose dumping and the patient would be receiving the medication all at once.

The facility's order for R2 about crushing medications for dysphagia would not apply.

During an interview on 10/16/25 at 1:50 p.m., the director of nursing (DON) stated she would be concerned if she witnessed nursing staff crushing a pill capsule instead of opening it.

The best practice is to open the capsule. If it was a medication that shouldn't be crushed, staff should clarify the order.

There would be concerns with crushing delayed release medication such as a faster response.

Nursing staff have been given training on administering delayed release medications and must pass competencies.The facility policy, Administration of Medication, last revised 6/25/25 directs the person administering medications must ensure that the right medication, right dose, right time and right method of administration are verified before the medication is administered.The facility policy, Medication Crushing Guidelines, undated, directs the nurse administering the medications should check to see that there is no contraindication to crushing the medications in question. If crushing is contraindicated, the nurse should consult the pharmacist for assistance in obtaining the medication in liquid form if possible.

The policy further directs that timed release tablets are designed to release medication over a sustained period and to achieve prolonged medication action.

These medications should not be crushed.

Enteric coated tablets are designed to pass through the stomach whole and dissolve in the intestinal tract to prevent destruction of the medication by stomach acid, prevent the medication from irritating the stomach lining or to achieve prolonged action from the medication.

Facility ID: