Sara Kinne
Article Annotation #1
Boul l at a, J . I. (2009 ). Dru g adm i ni st rat i on t hrough an ent er al feedi n g t ube. A JN , Amer i can Jour nal of
N ursi ng , 109(10 ), 3 4 -42. DO I: 10.1097/ 01.NAJ 0000361488.45094.28.
J os eph Boul at t a i s a pharm ac y sp eci al i st i n nut ri t i on support at t he Hos pi t al of t he Uni vers i t y of
P enns yl vani a and an associ at e pro fessor of pharm a col og y an d t herapeut i cs i n t he S chool of Nurs i ng at
t he Uni versi t y o f P e nns yl vani a. Th e art i cl e re com m ends g ui del i nes for adm i ni s t eri ng m edi cat i ons
t hrough ent eral f eed i ng t ubes, r ecom m e ndi ng adm i ni st eri n g each m edi cat i on s e parat el y. Th e y cont i nue t o
s a y you shoul d avoi d m i xi ng t oget her m edi cat i ons m eant t o go t hrou gh ent eral f eedi n g t ubes , gi ven t he
ri s ks of ph ysi c al an d chem i cal i ncom pat i bi l i t i es , t ube obst ruct i on, and al t ered d r ug r es pons es . Goi n g
furt her i n -d ept h t he art i cl e st at es “ It ’s h ard enou gh t o pr edi ct st abi l i t y for an y one dru g product al t ered
for adm i ni st rat i on t hrough a fe edi n g t ube; when m ore t han one dru g i s adm i ni s t ered at t he s am e t i m e,
predi ct i ng st abi l i t y and com pat i bi l i t y be com es even m or e di ffi cul t . Thus , when m ore t han one dru g i s
s chedul ed fo r adm i ni st rat i on, t he y m ust be gi v en sepa rat el y” (Boul l at a, 2009). T he i nt ended audi en c e of
t hi s ar t i cl e woul d be nursi ng o r m edi cal personnel who i nt e nd t o adm i ni s t er m edi cat i ons vi a ent er al
t ubes .
Art i cl e Annot at i on #2
Idz i nga, J .C ., de J ong, A. L., & v an den Bem t , P .M. L. A. (20 09). The ef fe ct of a n i nt ervent i on ai m e d at
reduci n g e rrors wh e n adm i ni st eri ng m ed i cat i on t hrough ent e ral fe edi ng t ub es i n an i ns t i t ut i on for
i ndi vi dual s wi t h i ntel l ect ual di sabi l i t y. Journal of Int el l ect ual Di sabi l i t y Res ear ch , 5 3(11), 932 -93 8.
DO I: 10.111/ j .1365 -2788.2009.01212.x .
The fi rst aut hor of t hi s art i cl e J .C . Idz i n ga, I was un abl e t o l ocat e c redent i al s fo r . C orres pondent Dr.
P at ri ci a van den Be m t i s em pl o yed b y Ut recht Inst i t ut e for P harm aceut i c al S ci ences , D epart m ent o f
P harm acoepi dem i ol og y and P ha rm acot h erap y. Thi s a rt i cl e f ocuses on previ ous s t udi es t hat s how fr equent
errors i n t he m edi ca t i on adm i ni st rat i on through ent er al t ubes. The y t h en l ook at i nt ervent i on pro gram s t hat
have be en proven t o reduce t h e am ount of erro rs i n adm i ni st rat i on. Accordi n g t o t he art i cl e t her e a r e
cl as s i fi cat i ons of m edi cat i on adm i ni st ra t i on errors, wi t hi n t hose cl assi fi cat i ons are s ubt ypes . A s ubt yp e
cat e gor y o f wron g a dm i ni st rat i on t echni que erro r i ncl udes n ot ri nsi ng t ube befo re, bet we en, and aft er
m edi cat i on adm i ni st rat i on, al so i ncorr ec t l y c rushi n g and di s sol vi ng al l m edi ci ne s i n one cup and
adm i ni s t eri ng t he m i x t ure i nst ead of one b y on e. Thi s art i cl e was m ore about t he erro rs of not s epa r at i ng
m edi cat i ons and t he program s t o fi x i t . It di d show t hat a ft e r i nt ervent i ons wer e i n pl ace t hes e
adm i ni s t rat i on error s were d ecr eased. T here i s no evi dent bi as i n t hi s art i cl e. I b el i eve t hi s art i cl e, l i ke t he
fi rs t i s i nt ended for nurses or m edi c al personnel who wi l l gi ve m edi cat i ons t hro ugh an ent er al t ube.
Art i cl e Annot at i on #3
Toedt er W i l l i am s, N . (2008). Medi c at i on adm i ni st rat i on t hrough ent eral f eedi n g t ubes . Amer i can Soc i et y of
Heal t h -Syst em Phar maci st s, Inc. , DO I: 10.2146/ aj hp080155.
The aut hor N anc y T oedt er W i l l i am s, P harm D, BC P S , BC NS P , i s Ass oci at e P rofes s or, P harm ac y
P ract i ce, C ol l e ge of P harm ac y, S out hwe st ern Okl ahom a S t at e Uni versi t y; s h e ha s cl ai m ed no pot ent i al
confl i ct of i nt erest . Thi s art i cl e provi de s an overvi ew o f ent eral f eedi n g t ubes a nd drug adm i ni s t rat i on
t echni ques. The art i cl e al so sa ys t hat i n corre ct adm i ni st rat i on m a y cause d ecr ea s ed dru g ef fect i ven e s s ,
i ncreas ed adve rse e f fect s, cl o gged feedi ng t ubes, or d ru g -fo rm ul a i ncom pat i bi l i ti es . The re com m end at i on
b y t hi s art i cl e for a dm i ni st rat i on of m edi at i ons t hrough ent eral f eedi n g t ube i s t hat t he y s houl d be gi ven as
a bol us and sepa rat e d from t he t ube fe ed . To do so you m ust fi rst fl ush t he t ube wi t h 15 t o 30m l before and
aft er m edi cat i on ad m i ni st rat i on. W hen yo u hav e m ul t i pl e m edi cat i ons t hat need t o be gi ven at t he s am e
t i m e, each m edi c a t i on needs t o be sep ar at ed i nt o di ffer ent dosi ng cups, and t h e t ube s houl d be fl us hed wi t h
5 t o 10m l of wat er b et ween each m edi cat i on. In a ddi t i on t o fl ushi ng bet w een m ed i cat i ons i t i s al s o
i m port ant t o di l ut e m edi cat i ons befor e adm i ni st rat i on, gen e ral l y w i t h 10 t o 30m l wat er.
Purpose- To validate the medication administration technique of separating medications before administering into an enteral feeding
tube.
Questions- Why are we able to administer a cup full of medications together to a patient if they take meds PO, but they have to be
separated meticulously prior to being put through a PEG tube?
Point of View- When I am preparing to administer several medications via PEG tube it is not only frustrating, but difficult to carry all
of these separate med cups. If I were giving these meds PO, the person would take them all at once, and they would reach the stomach
at the same time.
Information- I have never seen adverse happenings when meds are administered all together, and not separated out into different cups
and by 15 ml of water flush. Because, I have patients who are on multiple meds taken PO at the same time, liquids included, with no
medication interaction noted. Multiple sources cited in my research show a potential for interaction when all meds given together and
recommend separating medications by 5 to 10ml flush.
Concepts and Ideas- again my main concept would be my argument of the PO route. An example is a patient who takes medications
crushed; they are all mixed together in pudding or apple sauce together, and administered together.
Assumptions- I guess some people assume that if these meds are mixed together before going into the PEG there will be some kind of
drug-drug interaction.
Implications and Consequences- There are no different cost consequences to the patients or facilities, unless you consider saving
thousands of med cups over a month’s time not separating each med. I do not believe there are consequences of “mixing” medications.
Inference and Interpretation- from what I can conclude, policies are to separate each med, and flush with 15ml water. I am yet to
see any reasoning for that. Consequences of not separating medications can result in interactions between medications, and in turn
may cost the healthcare system more money.