king medicines, the doctor, practice nurse and pharmacist would have a duty to ameliorate that impairment. A person with swallowing difficulties may require their medication in a suitable format like a liquid rather than a tablet or capsule.
In October 2000, The Human Rights Act came into effect in the UK meaning that people in the UK can take cases about their human rights into a UK court. The "right to life" is fundamental and now enshrined in UK law. The Act states that: "Care must be given with respect and be proportionate to the needs of the person." Therefore, medication should be given in its safest form to protect patients from any adverse clinical outcome.
Royal Pharmaceutical Society of Great Britain (RPSGB), 2003
The RPSGB states that ‘If a formulation is tampered with then the product will be unlicensed. Pharmacists must consider and advise on the potential for distortion of bioavailability profile of the medicine.’ Pharmacists ‘must also consider whether alternative licensed products are available, such as the same drug with a different formulation or a different drug for the same indication.’
The Nursing & Midwifery Council (2007 and 2008)
The NMC has issued advice for registered nurses and standards for medicines management on the issue of tablet crushing. It advises nurses not to crush any medication or open capsules that are not specifically designed for that purpose, as by doing so the chemical properties of the medication could be altered.
The NMC states that "The mechanics of crushing medicines may alter their therapeutic properties rendering them ineffective and are not covered by their product licence. Medicinal products should not routinely be crushed unless a pharmacist advises that the medication is not compromised by crushing, and crushing has been determined to be within the patient’s best interest."
Nurses are reminded by the NMC that under the Medicines Act 1968, only medical practitioners can authorise the administration of unlicensed medicines to humans. It is therefore unlawful to crush a tablet before administration without the authorisation of the independent prescriber (Nursing & Midwifery Council 2007b).
A nurse who advises that a tablet is crushed or a capsule opened to assist with swallowing difficulties must proceed with caution. Even when an independent prescriber authorises a medicine to be administered by crushing a tablet a percentage of liability for any harm that is caused will still lie with the administering nurse. The balance of this liability would be assessed in court.