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Objectives: To determine the extent to which medications are altered or crushed prior to administration to residents of aged‐care facilities, the medications involved and the methods employed.

Method: Observation of medication rounds at a representative sample of South Australian aged‐care facilities.

Results: At least one medication was altered in 34% of the 1207 occasions of medication administration observed within ten residential aged‐care facilities in South Australia. 17% of medicines which were altered, had the potential, because of the alteration, to cause increased toxicity, decreased efficacy, unpalatability, safety or stability concerns. The process of altering medicines was found to be problematic. In all occasions where more than one medicine was altered, they were crushed together within the same vessel. In 59% of occasions where the same vessel was shared amongst residents, the vessel was not …