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Development and validation of INappropriate solid oral dosaGE form modification aSsessmenT (INGEST) Chart

  • At: PPR SIG 2021 (2021)
  • Type: Digital
  • By: TAN, Poh Leng (National University of Singapore, Singapore)
  • Co-author(s): Poh Leng TAN, Wing Lam CHUNG, Grant E. SKLAR, Kai Zhen YAP, Sui Yung CHAN
  • Abstract:


    Modification of solid oral dosage forms (SODFs), through the crushing of tablets or emptying of capsule contents, is performed regularly to improve swallowability in patients with dysphagia. However, by altering the integrity of formulations, it may compromise the effectiveness and safety of the drug treatment. In practice, information on suitability for crushing may not be available, updated, or conclusive.


    This study describes the development and validation of a novel tool, the INGEST Chart, to assist clinicians in promptly assessing the suitability of SODF modification during prescribing, medication reviews, or medication administration.


    During the development phase, relevant drug resources were reviewed for physical attributes of SODFs that preclude modification. Considerations such as the presence of special coatings, modified release characteristics and potential for irritation or toxicity were further categorised based on their relevance to patients’ feeding status before collation into the INGEST chart. Subsequently, to establish its inter-rater reliability, 3 experienced pharmacists applied the finalised INGEST chart independently to medication records of 50 randomly selected patients requiring SODF modification in a nursing home or an acute care hospital ward. Inappropriately modified medications identified by each pharmacist using the INGEST chart were compared and inter-rater agreement was calculated using Gwet’s agreement coefficient (AC).


    A total of 509 entries of oral medications belonging to the 50 patients were assessed for their appropriateness to be modified using the INGEST chart. Gwet’s AC among the three pharmacists was 0.75 [p < 0.001, 95% CI (0.63, 0.87)], suggesting substantial inter-rater agreement.


    The INGEST chart, a validated implicit tool to guide clinicians in assessing the suitability of SODF modification in the absence of explicit information, has been developed. Its utilization in daily practice may potentially improve clinical outcomes for patients with SODF dysphagia.

Last update 4 October 2019

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