Drug Modification by Nurses in Norwegian Nursing Homes: A Cross-sectional Study

Crushing and dividing pills among older patients in nursing homes appears to be a common yet not harmless practice. Because few updates exist regarding the role of nurses and their dispensing of drugs in nursing homes, this study sought to describe the occurrence, methods, and causes of nurses' drug modification and to examine possible factors associated with drug modification in this context. A cross-sectional study of 273 dispensing episodes of solid oral drugs made by nurses, were observed during day and evening shifts. Modifications were made in 20.5% of the dispensing episodes, including 80.4% where alterations were made by crushing and 19.6% where alterations were made dividing. The most commonly reported reasons for modification were 'swallowing difficulties' (53.6%) and 'lack of understanding by the patient' (19.6%). The logistic regression analysis showed a significant association between the occurrence of drug modification and both cognitive impairment and administration method.