fyi Tablet Splitting Devices & Margin of Error

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fyi Tablet Splitting Devices & Margin of Error (see below)

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Cris

Cris Kerr

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" The good we secure for ourselves is precarious and uncertain

until it is secured for all of us and incorporated into our common life. "

Jane Addams

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Medical experts issue warning about common practice of tablet splitting

6. January 2011

Medical experts have issued a warning about the common practice of tablet

splitting, after a study

found that nearly a

third of the split fragments deviated from recommended dosages by 15 percent or

more.

Their study, published in the January issue of the Journal of Advanced Nursing,

points out that the

practice could have

serious clinical consequences for tablets that have a narrow margin between

therapeutic and toxic

doses.

And they are calling on manufacturers to produce greater dose options and liquid

alternatives to

make the practice

unnecessary.

Researchers from the Faculty of Pharmaceutical Sciences at Ghent University,

Belgium, asked five

volunteers to split

eight different-sized tablets using three techniques commonly used in nursing

homes.

They found that 31 per cent of the tablet fragments deviated from their

theoretical weight by more

than 15 per cent and

that 14 per cent deviated by more than 25 per cent. Even the most accurate

method produced error

margins of 21 per cent

and eight per cent respectively.

" Tablet-splitting is widespread in all healthcare sectors and a primary care

study in Germany found

that just under a

quarter of all drugs were split " says study lead Dr Charlotte Verrue.

" It is done for a number of reasons: to increase dose flexibility, to make

tablets easier to swallow

and to save money

for both patients and healthcare providers. However, the split tablets are often

unequal sizes and a

substantial amount

of the tablet can be lost during splitting. "

The five researchers comprised a pharmacy student, researcher and professor, an

administrative

worker and a laboratory

technician, ranging from 21 to 55 years of age. With the exception of the

technician, none of the

other study

participants had tablet-splitting experience. The authors believe this

replicated nursing home

conditions where

splitting is not always performed by professional nurses.

Between them they split tablets into 3,600 separate quarters or halves using a

splitting device,

scissors and a kitchen

knife. The eight different tablets were different shapes and sizes, three were

unscored, three had

one score line and

the others had two.

The drugs were prescribed for a range of health conditions, including

Parkinson's, congestive heart

failure, thrombosis

and arthritis.

After splitting, each fragment was weighed to see how much they deviated from

the theoretical

weight.

Key results included:

* Using a splitting device was the most accurate method. It still produced a 15

to 25 per cent error

margin in 13 per

cent of cases, but this was lower than the 22 per cent for scissors and the 17

per cent for the

knife.

* The splitting device produced a deviation of more than 25 per cent in eight

per cent of cases,

compared with 19 per

cent for the scissors and 17 per cent for the knife.

* Some drugs were much easier to split accurately than others. The easiest to

split produced an

overall error margin (15

per cent deviation or more) of two percent and the most difficult tablets

produced an error margin

of 19 per cent.

" Tablet splitting is daily practice in nursing homes " says Dr Verrue. " However,

not all formulations

are suitable for

splitting and, even when they are, large dose deviations or weight losses can

occur. This could have

serious clinical

consequences for drugs where there is a small difference between therapeutic and

toxic doses.

" Based on our results, we recommend use of a splitting device when splitting

cannot be avoided, for

example when the

prescribed dose is not commercially available or where there is no alternative

formulation, such as

a liquid.

" Staff who are responsible for splitting tablets should receive training to

enable them to split as

accurately as

possible. They should also be made aware of the possible clinical consequences

of dose deviations.

" We would also like to see manufacturers introduce a wider range of tablet doses

or liquid

formulations so that tablet

splitting becomes increasingly unnecessary. "

http://www.news-medical.net/news/20110106/Medical-experts-issue-warning-about-co\

mmon-practice-of-tablet-splitting.aspx