Medication Safety Risks Associated With Inappropriate Use of Non-Crushable Tablets in Enterally Fed Patients: A Nationwide Cohort Study

BACKGROUND AND OBJECTIVES: Hospitalized patients receiving enteral feeding are at high risk of medication administration errors. In clinical practice, non-crushable oral tablets may be inappropriately prescribed, potentially resulting in adverse outcomes. This study examined the association between inappropriate use of non-crushable oral tablets during hospitalization and early post-discharge emergency department (ED) visits among patients receiving enteral feeding. METHODS: We conducted a nationwide population-based cohort study using a national health insurance claims database in 2020, including 173,476 hospitalized patients receiving enteral feeding. Cox proportional hazards models were used to estimate the association between inappropriate use of non-crushable tablets and the hazard of the first ED visit during the 3-day post-discharge follow-up period. RESULTS: Among 173,476 patients, 40.2% were exposed to inappropriate medication use. Exposure was associated with a significantly higher hazard of a first ED visit during the 3-day post-discharge follow-up period (adjusted hazard ratio, 1.954; 95% confidence interval, 1.721-2.217). The association varied significantly across age groups and inpatient departments, with the largest adjusted hazard ratios observed among patients aged <65 years and those treated in hematology and oncology, infectious diseases, and neurosurgery. Selected comorbidities, including hypertension, cerebrovascular accident, and dementia, were also associated with a higher hazard of an early ED visit. CONCLUSION: Orders for non-crushable tablets among hospitalized patients receiving enteral feeding were common and were associated with a substantially higher hazard of an early post-discharge ED visit. The association varied across age groups and inpatient departments, although these subgroup findings should be interpreted cautiously. These findings highlight an important medication safety concern during transitions of care and support further evaluation of system-level strategies, including prescribing safeguards, clinical decision support, and multidisciplinary medication review, to improve the quality and safety of medication management.