Swallowing difficulty, crushing and capsules

Some adults cannot swallow tablets or capsules safely. Swallowing can worsen after stroke, with dementia or Parkinson's disease, with frailty, acute illness, mouth pain, dry mouth or anxiety. Staff must not treat tablet crushing as a convenience or routine shortcut.

NHS Specialist Pharmacy Service guidance states that not all tablets may be crushed and not all capsules opened. Modified-release preparations, coated tablets and certain high-risk medicines can become unsafe, ineffective or harmful if altered. Crushing or opening medicines can also release dust that may be hazardous to staff.

What care staff should do

• Escalate new swallowing difficulty: sudden or worsening dysphagia requires clinical review and possibly a speech and language therapy assessment.
• Check the care plan: written authorisation is needed before giving medicines in food, thickened fluids or in an altered form.
• Check the label and MAR: instructions should be clear and reflected on the dispensing label and MAR or eMAR where possible.
• Ask pharmacy or prescriber: never assume a tablet can be crushed or a capsule opened without professional advice.
• Use the right food or fluid: follow specific swallowing recommendations, dietary restrictions and pharmacist guidance.
• Give one at a time where possible: this helps confirm which medicine the person has taken.
• Record and monitor: document administration, refusal, incomplete doses, coughing, choking, side effects or changes in effectiveness.

Giving medicine in food or drink with the person's knowledge and consent is not covert administration. Hiding medicines so the person does not know they are taking them is covert administration and requires the formal process described earlier.

Do not crush, open or mix medicines unless the care plan and authorised advice say it is safe for that specific medicine and person.