ORIGINAL RESEARCH Tablet-splitting: a common yet not so innocent practice Charlotte Verrue, Els Mehuys, Koen Boussery, Jean-Paul Remon & Mirko Petrovic Accepted for publication 6 August 2010 Correspondence to C. Verrue: e-mail: charlotte.verrue@ugent.be Charlotte Verrue PharmD PhD Post-doctoral Researcher Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Belgium Els Mehuys PharmD PhD Post-doctoral Researcher Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Belgium Koen Boussery PharmD PhD Post-doctoral Researcher Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Belgium Jean-Paul Remon PharmD PhD Professor of Pharmaceutical Technology Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Belgium Mirko Petrovic MD PhD Professor of Geriatrics Department of Geriatrics, Ghent University Hospital, Belgium VERRUE C., MEHUYS E., BOUSSERY K., REMON J.-P. & PETROVIC M. VERRUE C., MEHUYS E., BOUSSERY K., REMON J.-P. & PETROVIC M. (2011) (2011) Tablet-splitting: a common yet not so innocent practice. Journal of Advanced Nursing 67(1), 26–32. doi: 10.1111/j.1365-2648.2010.05477.x Abstract Aim. This paper is a report of a study conducted to quantify (i) the mean deviation from theoretical weight and (ii) the mean weight loss, after tablet-splitting with three different, commonly used splitting methods. Background. Tablet-splitting is a widespread practice among all sectors of health care for different reasons: it increases dose flexibility, makes tablet parts easier to swallow and allows cost savings for both patients and healthcare providers. How- ever, the tablet parts obtained are often not equal in size, and a substantial amount of tablet can be lost during splitting. Method. Five volunteers were asked to mimic the situation in nursing homes and to split eight tablets of different sizes and shapes using three different routine methods: (i) with a splitting device (Pilomat Ò ), (ii) with scissors for unscored tablets or manual splitting for scored tablets and (iii) with a kitchen knife. Before and after splitting, tablets and tablet parts were weighed using an analytical balance. The data were collected in 2007. Results. For all tablets, method 1 gave a statistically significantly lower mean deviation from theoretical weight. The difference between method 2 and method 3 was not statistically significant. When pooling the different products, method 1 also induced significantly less weight loss than the two other methods. Conclusion. Large dose deviations or weight losses can occur while splitting tablets. This could have serious clinical consequences for medications with a narrow ther- apeutic-toxic range. On the basis of the results in this report, we recommend use of a splitting device when splitting cannot be avoided. Keywords: nursing, nursing homes, practice guideline, tablet-splitting, weight deviations Introduction Tablet-splitting is a widespread practice internationally in all sectors of health care. A study in primary care in Germany showed that 24Æ1% of all drugs were split (Quinzler et al. 2006). There are multiple reasons for this practice. First, splitting tablets improves dose flexibility, which is important when doses need to be adapted to the specific needs of certain patient populations (e.g. older adults, children) or when doses need to be thoroughly titrated (Fischbach et al. 2001). Second, it makes the different tablet parts easier to swallow. Finally, it could allow cost savings for both 26 Ó 2010 Blackwell Publishing Ltd JAN JOURNAL OF ADVANCED NURSING