Select patients carefully. Establish screening criteria for patients before prescribing or dispensing half-tablets to ensure that patients have the required level of understanding, ability and motivation to share tablets.1,2 Ensure that the patient understands the risks associated with splitting tablets. If the patient cannot be expected to share their own tablets, seek help from a qualified family member. (Note: In some states, it may not be legal for a pharmacist to share tablets if the dose is commercially available1). In the article on splitting tablets to save money, Clark identified some additional risks:1 In this case, no one could be sure of the dose the patient had taken before her hospitalization. But a VA study showed that most people took too many medications because they forgot to share their pills.2 Between January 2001 and April 2005, the VA`s National Center for Patient Safety database contained 442 reports related to pill splitting. Of these, 38% were considered adverse events, primarily on an outpatient basis (65%). Two-thirds of patients received more than the expected dose. Pharmacists discovered these errors because patients arrived too early to refill their prescriptions. A quarter of the drugs were highly alerted drugs. Approximately 9% of patients were adversely affected by these errors; 2% required hospitalization. In more than half of the events, participating cans were commercially available.
Problem: Most oral medications are commercially available in the dosages most commonly prescribed to patients. Sometimes the exact dose of the patient is not commercially available, so more than one tablet or only part of a tablet may be needed. Although the use of more than one tablet for a single dose is common, tablet splitting has become more common in the last 5 years for several reasons: Prescribe based on weight. Prescribing physicians should prescribe the drug concentration and “mg” dose whenever possible to avoid misinterpreting an order for a “1/2” tablet as 1-2 tablets. When considering dividing a tablet, you and your doctor should keep the following in mind: At some point, your healthcare or managed care company may have recommended a pill split, for example to adjust the dosage of your medication or reduce costs. In such cases, it is your doctor`s responsibility to monitor the effects of the risks associated with the practice of tablet fractionation. You should always talk to your doctor before sharing a tablet, and don`t be afraid to ask questions if you plan to share tablets. Check the suitability. Before prescribing, administering or administering half tablets, check the references of the medications to make sure they are safe. If in doubt, contact the manufacturer.2 Give fractional tablets to hospitalized patients. In hospitalized patients, pharmacy staff should dispense specific doses by dividing and repackaging tablets or preparing an oral solution for each dose in a unit-dose oral syringe. Nurses should not be expected to split tablets.
Later, the doctor lowered the dose to 5 mg twice a day. Instead of filling out the new prescription for 5 mg tablets, she tried to find all the 10 mg tablets to split them in half, but some stayed whole. In this case, no one could be sure of the dose the patient had taken prior to hospitalization. Keep it clean. Patients and health care providers who share tablets should wash their hands first. Health care providers should also wear gloves. If a tablet splitting device is used, it must then be washed to remove the powder or particles. Safe practice recommendations: Health care providers should strive to use commercially available oral tablets when available in both hospital and outpatient settings. However, tablet décolleté may still be necessary if the drug is not commercially available at the patient`s specific dose or if the patient`s inability to pay for the medication on an outpatient basis outweighs the risks associated with tablet décolleté. In these circumstances, consider the following suggestions from Clark, VA and ISMP: Patient-related factors. First, it`s easy for patients to get the right dose wrong.
One woman learned this when she was hospitalized for unstable angina and high blood pressure. Her doctor determined that she had taken the wrong dose of lisinopril. She was supposed to take 5 mg twice a day, but the prescription label said there were 10 mg tablets in the bottle. When the doctor looked inside, he saw pink and peach tablets, some of which were split in two. Initially, the patient had taken one 20 mg tablet of BID. When her doctor lowered the dose to 10 mg twice daily, she had filled the new prescription. The patient then cut the remaining 20 mg tablets in half and placed them in the same vial that contained the 10 mg tablets. Later, his doctor lowered the dose to 5 mg twice a day. Instead of filling out the new prescription for 5 mg tablets, she tried to find all the 10 mg tablets to split in half, but some stayed whole.