Resolve Designs

There are suggestions to mitigate exposure to hazardous meds posted throughout this Forum. We cannot say that RxCrush meets all USP<800> guidelines, that would require something equivalent to a CSTD (Controlled System Transfer Device) for solid medications which RxCrush does not qualify for. RxCrush does control solid material and liquid forms of the pill crushing process but doesn't contain vapors when the medication mixture is exposed to the air when the syringe is disconnected from the pill pouch. USP<800> does recommend that hazardous meds be contained in a plastic pouch while crushing, but also advises that hazardous drug handling protections of proper PPE, negative atmosphere containment and transportation protections be used to limit hazardous exposure.

Updated recommendation: For most medications 20ml to 35ml ENFit syringes are optimum. This size provides enough liquid to dissolve crushed medication in the RxCrush Pouch PP06, depending on the medications. More than one cycle of irrigation is still recommended to deliver almost all of the medication dose. Reply 0

We now have prototypes of a new small pouch that can prepare doses in as little as 1ml of liquid. We have samples to send if requested through Sales@RxCrush.com.

For most medications 20ml to 35ml ENFit syringes are optimum. This size provides enough liquid in most cases to dissolve crushed medication in the RxCrush Pouch PP06, depending on the medications. More than one cycle of irrigation is still recommended to deliver almost all of the medication dose.

As of 2/28/2022 every pharmacist surveyed from among RxCrush customers, recommends that only one medication be crushed in a dose. That may include several pills of the same medication but not a mix of different medications.

As of 2/28/2022 every pharmacist surveyed from among RxCrush customers, recommends that only one medication be crushed in a dose. That may include several pills of the same medication but not a mix of different medications.

Wipe any excess jelly from around the shaft.

The FDA and USP have different opinions about how long medications can be kept after compounding. Also there has been a question about how far a medication can be transported out of the pharmacy for safety. Premier Inc has issued an opinion letter to the FDA encouraging the FDA and USP to align their guidance. The letter is accessible through Premier Inc's web site. https://www.premierinc.com/newsroom/policy/premier-recommends-compounding-reforms-to-prevent-drug-shortages

Many of our new customers are implementing RxCrush in their facilities and are working to comply with USP<800>. Here's a presentation that gives some guidance when preparing protocols for preparing doses of medication. "To Crush or Not to Crush: Challenges & Risks of Crushing & Compounding Medications in the New Era" was presented by Pharmacy Purchasing & Products by webinar on November 2, 2021. The presenter, Huda Cotta-Dethlefs, PharmD of NexRx Solutions and sponsored by CMP Pharma gave an overview of the issues about compounding. The full presentation can be found here: pppmag.com/tocrushornot

See video prepared by Julie Weiler, Nurse Educator at Elkhart General Hospital and posted on this web site under How to Use

Question asked by Dawn Kregel of JPS Health June 29, 2021: "we have a metal pill crusher, we need to know best practices for keeping clean of residue" The best way to eliminate residue from pill crushers is to use the Rx Crush Pill Pouches while crushing meds. The pouches are completely sealed after the pills are inserted and a syringe is attached to the ENFit port. Pill dust and liquid are completely contained while using the protocol that is described on our web site under the How to Use tab or under the RxCrush Store page. Each product picture has enlarged and multiple view pictures when you click on the "Quick View" pop up. There are also short videos showing how the different pieces can be attached. One pouch shown, PP10 doesn't connect with a syringe. It does contain pills while crushing and prevents pill dust from contaminating the crusher. When the top of this pill pouch is removed there is a possibility of pill dust spreading as the contents are poured into another container. Recommended cleaning agents are listed in this thread.

See the attached file describing the best solutions for cleaning the Pill Crusher.

Kristy, Here's what we learned with the assumption that medications will be crushed first, water added to dissolve the crushed medication, then thickened in another container. This is the preferred protocol for preparing the thickened med mixture. Adding the thickening powder/agent to mix in the pouch is difficult as the mixture in the pouch becomes more viscous. Thicker liquids can't be mixed as evenly in the small space of the pouch as the mixture thickens. We're assuming crushing medications is necessary first step which is best done by the Rx Crush system using the Rx Crush pill crusher and Rx Crush Pill Pouches.

That is correct. Using the protocol carefully does prevent any drips or leakage of medication during the process. Also interesting is our bench test data that Rx Crush Pill Pouches when attached to an ENFit syringe can withstand up to 5psi of pressure which is within normal use parameters.

Assuming applesauce is used to administer medication orally, not through enteral feeding tubes, applesauce can be used in an Rx Crush Pill Pouch to mix crushed medication. Applesauce or other foods like syrup need to be diluted just enough to allow thicker liquids to pass through the ENFit opening of the pouch and to be drawn into a syringe. There may need to be more than one irrigation of the pill pouch to dissolve/absorb all the applesauce and medication in the pouch.

A video showing the process to crush, dissolve, and extract medication from the pill pouch can be found on the "How to Use" section of this web site. At about the 2:00 min mark through 2:20 there are steps that keeps liquid from dripping out of the pill pouch while transferring into a syringe. Positioning syringes and pouches upright, (pouch up, syringe below) keep the liquids from leaking out of pouches while extracting. Any ENFit, Luer, Catheter or Oral style syringe work in the same fashion, with the appropriate adapter attached to the pouch and syringe. There is a possibility of leakage if the pouch and syringe is held the other way with the pouch opening down instead of up. Also outside pressure on the pouches and syringes is meant to me mild not at high pressure.

There have been several inquiries about how long can medication be stored in the pill pouch after crushing. The consensus so far is that the crushed medication can last at least as long as the pill would last in a pill bottle, providing the pouch is either capped with CA02 or CA03 or with a syringe attached. As long as the pouch is closed with one of the caps or syringes and there is no liquid in the pouch the medication is protected from oxidation and should preserve the properties of the medication at least as long as if the pill is stored in a bottle. The pouches are clear so UV deterioration is not protected. Pharmacists who are familiar with the properties of each med should make the determination.

See all USP Information at: USP.org

Chlorine, alcohol, or hydrogen peroxide based wipes are effective in cleaning surfaces of the Rx Crush Pill Crusher. Use wipes that are meant for hard surfaces for disinfecting in hospitals like: PDI - Super Sani Cloth Clorox Healthcare Hydrogen Peroxide Cleaner Disinfectant Wipes Allow the surfaces of the Pill Crusher to dry and don't use a paper towel to dry off unless the towel is also anti-fungal, anti-germ.