Capsules with pelletized medication are made to deliver medication into the metabolism on time-release. Be aware of the characteristics of the capsulized medication before crushing.

Best practices to date: Cut the top off a capsule and pour the granules or pelletized meds into the pouch. Seal the pouch and attach a syringe with liquid. Crush the pellets in the pouch, then inject water to dissolve the meds. The solution can be extracted from the pouch with the attached syringe and then injected into feeding tubes or into food.

Total liquid capacity of the PP08 Pediatric Pill Pouch is 30ml. Optimal ENFit syringe size is 10ml.

We have learned there are 2 manufacturers of ENFit .5ml Syringes. One is NeoMed and also Medela.

When adding pills into applesauce or pudding, use the PP10 Pill Pouch to crush the medication then tear off the top of the pouch and pour the pill powder into the food substance. Take a look at the item here: https://www.rxcrush.com/product-page/pp10-rxcrush-pediatric-sealed-tear-off-pill-pouch-qty50

Smaller volume pouches are now available. On the web site Store page see Item PP08. It's designed like the larger PP06 pouch, with ENFit nozzle but smaller and has proven to be useful for patients who are liquid sensitive. Pills can be crushed in the smaller pouch using as little as 1ml of liquid.

There is guidance about crushing medications and avoiding errors that can be uncomfortable for the patient and healthcare workers. This article by Matthew Grissinger, RPh, FASCP as published in P&T. 2013 Oct; 38(10): 575-576 recommends best practices for the administration of crushed medications. The article specifically recommends crushing one medication at a time. Footnotes at the end of the article point to literature with detailed descriptions of medications that shouldn't be crushed and medications that shouldn't be mixed.

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.