LITTLE HERO

Chantal Bout - January 03, 2020



The main objective of any surgeon is to save lives or to improve and prolong people’s lives on a daily basis. Surely that must be one of the best jobs in the world. It is certainly one of the most important ones.

 

You have studied years on end to become a surgeon and every year you receive more training to make sure your skills and knowledge remain of the highest possible standards. 

 

Fragments of your day

You greet your patient and reassure them. They put all their trust in you to take good care of them, and go off to sleep knowing that you will have their best interest at hand. Hoping you will make their life just a bit better than it used to be, or at least safer. 

You perform the surgery, focussed on what needs to be done, doing that what you are trained for, and you do it to the best of your capacity, providing this patient with the best care as this is your specialty. 

No matter your surgical speciality, as a surgeon, it’s magic what you do.

Hours after you started the procedure you are ready to close. Even the scar becomes a work of art as that is what your patient will look at for the rest of their life. 

 

It is time for the patient to wake up and for the trachael tube to be removed.

As the patient is transported to the recovery, you complete the paperwork, including the prescription of medication that the patient will need to take after the procedure, whether it is for a few days or the rest of his life. 

 

Take your pills

Little HeroAnd this is where you unknowingly hit a big blank. 

It turns out that your patient has trouble taking oral medication, swallowing pills doens’t go well. Either because the brain just signals to not take those ‘big, nasty tasting’ pills or perhaps this person has another illnesscausing a form of dysphagia. 

 

Research tells us around 40% [1] of the population has problems with the oral intake of medication, so it is an actual problem.  

As a surgeon you need your patients to take your prescription, it’s important and sometimes even lifesaving.

So the patient does not dare to tell you that there’s an issue with the intake of medication.

 

This can lead to a few different scenarios;

 

Crushing it

Your patient tells the nurse on the ward that there’s a problem swallowing pills. The nurse wants to help out and decides to crush the medication, just to make your ptatients’ live easier. 

 


However, the nurse isn’t aware that a slow release tablet is not supposed to be crushed at all. Because of crushing a medication dose dumping takes place.

Your patient gets into serious trouble because of a severe overdosage of his medication [2]

 

You are called in on the patient. However, you don’t have a clue that crushing medication is actually causing this major problem.

 

Apple sauce to the rescue

Your patient tells the nurse on the ward that there’s a problem swallowing pills. The nurse of course wants to help out and decides to give the medication with Apple sauce, just to make it easier and the Pharmacist always says that it can’t do any harm to combine medication with apple sauce.

 

However, the nurse isn’t aware that the Celiprolol [3] just administered is now working for only 20% because the bioflavonoids in apples cause a blockage in the intestines. The medication isn’t being absorbed like it’s supposed to be. 

 

The nurse calls you and suggests that the dosage to be increased as the patient is not responding to it as expected. You decide to increase the dosage which would not have been necessary if administered correctly.

 

Yoghurt does the trick

Your patient tells the nurse on the ward that there’s a problem swallowing pills. The nurse obviously wants to help and decides to put the pills in yoghurt and administers it that way. 

 

However, the nurse isn’t aware that yoghurt covers the pills too well. The stomach and intestines do not digest the actual medication in full and a significant lower dosage is being absorbed [4]

 

You are called because the patient isn’t responding to the medication as expected. It’s a riddle as to why.

 

Little Hero

Great pretender
Your patient is too ashamed to tell the nurse that there is a problem swallowing meds. This particular subject is still taboo for many people around the world, especially the older generations. As a solution the patient decides to get rid of them, flushing them down the toilet and not taking anything at all.[5] 

 

The nurse has no clue. You have no clue. 

Therapy loyalty is zero in this case, and nobody understands why the medication is not doing what they are supposed to. 

This actually happens on a daily basis, even in cases where therapy loyalty is life saving.

 

Thick water

The patient receives his medication, but suffers from a form of dysphagia. The nurse wants to help and decides to add a traditional food thickener to some water.

 

However, the nurse isn’t aware that this will cause a massive under dosage of any medication [6]

The main ingredient in traditional food thickeners is xanthan gum. While it may be a fantastic thickener to be used for the intake of fluids, if you combine medication with the same subtance, it will interact. 

Xanthan gum is broken down in the colon. Medication needs to be absorbed in the stomach and duodenum. The gum covers the medication in a thick and sticky fibrous substance, making the medication unrecognisable to the body. As a result it won’t be absorbed completely. Reports have described that xanthan gum can decrease medicaion dosages to little as a third of the intended dosage.  

 

Solving the riddle

I have spoken with many surgeons around the world and I haved worked with specialists for a long time now. I have asked many doctors if they are aware of what exactly happens after prescribing medication to their patients, whether it is in the hospital or at home. 

There are many medicines that have a small therapeutic bandwidth and it is essential that these meds are being taken the way they are supposed to be taken. 

 

There are numerous studies covering all sorts of interactions. As it turns out, there will be an interaction with combining almost every food item with almost every medication.

The issue at hand is nobody knows exactly which combinations are safe and which ones are not [7]

 

There is a way to take away all unknown interactions by using a little heroic aid that is safe and suitable for every patient [8] and for every medication. 

 

The work that you do on a daily basis in the OR deserves to be supported by the right medication in the right dosage. The recovery chain could be massively improved by giving your patients a simple choice between taking medication with water or a special swallowing gel. 

 

Setting a new standard for the intake of medication in your facility

Many surgeons agree that proper medication is an essential part of the recovery and wellbeing of the patient.

We need to raise awareness on what not to do with medication within our hospitals. It will result in mere positives when the complete procedure of medication administration is standardised.

 

Once your patient leaves the OR you should be sure they are taken care of in the best way possible. From a good meal to the right bandage, and most certainly a good therapeutic loyalty to the medication you prescribed to them. 

 

Let your nurse talk to the patient and ask them whether there is a problem with taking medication. The solution is too simple not to include. 

 

Perhaps it’s not the sexiest aspect of your job and maybe this is exactly why it should be standardised, so you can be sure that the medication is always administered to the patient the way you intended. Without unwanted and often still unknown interactions. 

 

Nowadays you definitely should check whether or not your patient can take the medication like intended. Provide that extra care for your patients with the help of a little hero called Gloup.

 




About the author

 

Chantal Bout is an experienced nurse and medical device expert at Rushwood, raising awarenees for problematic medication intake.

She is passionate about healthcare and about Gloup. It may seem insignificant and even sound a bit funny, but it can make a huge difference for your patients and your own peace of mind.

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Work by the School of Pharmacy, University of Queensland, Brisbane, QLD, Australia team: Lucia Crinó, Yady J Manrique Torres, Julie A Y Cichero & Kathryn J Steadman. As noted on Slide: “Acknowledgement to Chandramouli Radhakrishnan, PhD candidate UQ School of Pharmacy for results of paracetamol in water thickened with a commercial thickener containing xanthan gum.

 

 

Contact Chantal 

Per email at [email protected]

or call her at +31 6 15 56 48 43


For more information on Gloup, visit 
www.gloup.eu

 

References 

  1. Carnaby- Mann, G. and Crary, M. Pill swallowing by adults with dysphagia. Archives Otolaryngology Head and Neck Surgery. Nov 2005:131(11):970-975.
  2. SHPA Carol Simmons, Medicines information Pharmacist, Fremantle Hospital and health service, Society of hospital pharmacists Australia. 
  3. Lilja, J.J., Junti-Patinen, L. & Neuvonen, P. J. Orange juice substantially reduces the bioavailability of the beta- andrenergic- blocking agent celiprolol. Clin.Pharmacol. Thep. 75, 184-190 (2004).
  4. Food- drug interactions Rabia Bushra, Nousheen Aslam, Arshad Yar Khan College of Pharmacy Ziauddin college of Pharmacy received 17 Oct 2010, Accepted: 09 Dec 2010 OMSB, 2011.
  5. Carnaby- Mann, G. and Crary, M. Pill swallowing by adults with dysphagia. Archives Otolaryngology Head and Neck Surgery. Nov 2005:131(11):970-975.
  6. Thickening agents used for dysphagia management: effect on bioavailability of water, medication and feelings of satiety. Julie A.Y. Cichero, nutritional Journal 2013 12:54. DOI: 10.1186/1475-2891-12-54.
  7. Interacties tussen voedingsmiddelen en geneesmiddelen, Loes Sissingh-Blok. 
  8. Work by the School of Pharmacy, University of Queensland, Brisbane, QLD, Australia team: Lucia Crinó, Yady J Manrique Torres, Julie A Y Cichero & Kathryn J Steadman. As noted on Slide: “Acknowledgement to Chandramouli Radhakrishnan, PhD candidate UQ School of Pharmacy for results of paracetamol in water thickened with a commercial thickener containing xanthan gum.

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