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The Evolution of Pill Crushing

We have to crush pills sometimes.  Either the patient (through aversion or physical limitation from stroke) can’t swallow whole pills so we crush them and put them in applesauce, or the patient gets their pills through a tube, so we crush them and dissolve them in water.

When I started nursing, we had a mortar & pestle.  (Yes, it’s an affiliate link.  They all are.)

mortar__pestle_large2

Anyway, this is what we used to crush pills.  (Pro tip:  the mortar is the bowl, the pestle is the bat-shaped object)  I always found it very satisfying to fill the mortar with pills and grind them up with the pestle. Of course, we had to then clean both very well afterwards to avoid cross contamination of pills, but overall it was a good system and worked well.  It felt good to crush up the pills and also offered a gratifying CRUNCH sound. Bonus:  Whenever the mortar would inexplicably get separated from the pestle, you could still crush pills!  You’d just take the pill (still in its package), put it on the counter and bang the hell out of it.  A professionally and socially acceptable way to vent your frustrations :)

Cost?  About $10.

Then came along the plastic pill crusher:

pillcrusherThis is a very simple contraption.  You put the pills in, then you affix the top and turn … it’s like a giant screw.  Every once in awhile I’d get the pills in there just right, and would be rewarded with a very lovely CRACK.  Unfortunately, it wasn’t extremely efficient – I’d usually have to unscrew it, jiggle the pills and redo it a few times in order to get them ground up enough to dissolve in water.  Cost?  About $5.

For whatever reason, TPTB decided to do away with the mortar and pestle and pill crusher.  Our then-manager decided to get us something called the Silent Knight.  Maybe the cross contamination became an issue, I don’t know.  But with this device, you would put the pills in a plastic pouch and crush them.  You’d then dump the crushed-up pills out of the pouch into a med cup, mix with water, and viola!  The only clean-up involved was throwing the pouch away.

SilentKnight

This device was pretty handy, I guess.  No pleasing cracks or crunches, unfortunately, either tactile or aural.  Cost: about $90, and from what I’ve seen, pouches are about 5 cents apiece!!  Doesn’t seem like much, but it adds up, and keep in mind that the pouches end up being one more thing taking up space in the trash.  Boooo!

Recently, a new contraption showed up in our med rooms – the First Crush.

FirstCrushwithCups

Now we’ve gone completely automatic!  You put the pills into one cup, put the second cup on top (so that they nest, not form a dome) and put it in the machine.  Then you choose the desired level of crushedness (“standard” or “extra grind”) and press a button.  It then whirs into action!  Whereas the Silent Knight is, well, silent, this machine isn’t very quiet at all – you get all kinds of cracks and crunches and machine-like sounds.

It’s very efficient, but also a bit wasteful as well.  You can add water to the bottom cup containing the pill powder and use that instead of the medicine cup, but you just throw away the top cup, which is wasteful.  The bottoms of the cups are “wavy” and the pill powder often gets stuck in the waves and it takes awhile to stir it all up.  The cups cost about 5 cents apiece, and you need to use 2!  If it were just one, it would be okay since you would have had to use a med cup anyway.  Cost: About $200-300 plus the cost of cups.

So we’ve gone from the mortar and pestle, which is cheap, immensely satisfying to use and creates no extra waste, to this electric machine that’s a whole lot bigger, a whole lot more expensive, and creates a whole lot more waste.

WTF?  If they’d kept the mortar and pestle in the med room, I’d just continue to use it, but they got rid of it!

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Comments

I have only used the silent knight and sooo not impressed. It seems like it just turns pills into a compacted little powder pancake that doesnt want to break apart for anything! Was hoping review of the first crush would be good, but bummer! Where can one find a mortar & pestle these days….lol

Ah, hospitals, the land of infinite waste. It was Earth Day last week…I simply laughed.

We use the Silent Night…at my last hospital, we used something that wasn’t pictured above, but it was quite, quite noisy.

Your descriptions and the names of these products are hilarious. You remind of myself when I first started driving big trucks…I was fascinated by the whooosh sound when you applied the parking brake. Probably, though, if you used the mortar and pestle for long enough, it would turn into nothing but a grind.

Lou Barba

Interesting post. Sure does make you wonder whether technology actually helps or hinders us. Especially when the original simolest idea seems to be the best! Thanks for sharing.

We have the mortar and pestle, but most often I will just grab a blood culture bottle and crush them in their plastic package with it (smush the pills with the bottom and then crush them up well by using the bottle as a mini rolling pin)

In my ICU we still have both the mortar & pestle and the Silent Knight! but everyone prefers to use the mortar & pestle.

As time passes by, technology had given way to the extinction of some of the best medical instruments to make way to crap medical equipments. Whew! Quite ironic, eh

Wow….I would love to have the mortar and pestle back! I haven’t used the automatic crusher but have used the others and the mortar and pestle was more effective. I figured it was taken from us due to Joint Commission requirements.

I like to first smash the pill in the unit dose package wtih hemostats, then run a little hot water into the med cup, drop the pill pieces in it, and then crush with a second med cup and an optional smooshing instrument, if necessary. Usually, it’s not.

I personally utilize this method: “You’d just take the pill (still in its package), put it on the counter and bang the hell out of it.” with any object around that is hard – sometimes a market, sometimes a phone – if I need to crush just one, there is no sense in wondering around aimlessly looking for a pill crusher.

I have seen all these being used. That specific plastic pill crusher is flimsy. the Silent Knight is ok. The automatic pill crusher is great but expensive. the top two pill crushers in my opinion are the Metal Pill Crusher for a table top crusher, or the hand held pill crusher which you can find an informational video on showing it’s ability to work easily here:
http://www.facebook.com/video/?id=194417787283452

I use 2 spoons!! We have the little plastic thing but youu may end up with CTS by the time it actually gets crushed! Thanks Gina. TurnerNurse

Come on!!! Mortar and Pestle cause a lot of RSI injuries. That’s why we shouldn’t use them.

Eh. I don’t crush pills enough to get RSI from that.

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a nursing student, i was told to crush two big fat tylenol and mix with megace..? huh,, that was near impossible in a facility where the pill crusher was locked up in the narcotic room.. so i have been looking for pointers from pros!

I have seen all these being used. That specific plastic pill crusher is flimsy. the Silent Knight is ok. The automatic pill crusher is great but expensive. the top two pill crushers in my opinion are the Metal Pill Crusher for a table top crusher, or the hand held pill crusher which you can find an informational video on showing it’s ability to work easily here:

Either the patient (through aversion or physical limitation from stroke) can’t swallow whole pills so we crush them and put them in applesauce, or the patient gets their pills through a tube, so we crush them and dissolve them in water.

Very interesting facts concerning the evolution of the pill crusher. It’s like we’re paying more for the “upgrades”, but in turn, is it helping with the cross-comtamination issues? If so, then it’s worth it I guess.

Thanks for the humor and knowledge. This is my first blog post and it is part of my Masters in nursing.

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  • profileI am Gina. I have been a nurse for 15 years, first in med/surg, then CVICU, inpatient dialysis, CCU and now hospice. This blog is about my experiences as a nurse, and the experiences of others in the healthcare system - patients, nurses, doctors, paramedics. We all have stories!

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