r/nursing • u/_neutral_person RN - ICU 🍕 • Jul 24 '22
Nursing Hacks Silent Knight Pill Crusher
It sucks at crushing pills. That is all.
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u/ChazRPay RN - ICU 🍕 Jul 24 '22
Crushing pills the provided plastic sleeve and realizing that most of the pills remnants are still adhered to the inside of the sleeve unless you take warm water and swish it all around then mixing it into a container with every other crushed med and beneprotein and miralax and liquid Senna and hoping the OGT doesn't clog. Also realizing the irrigation set up in the room was from 7 days ago and the OGT is coiled in their mouth.
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u/Hrafnastickchick RPN 🍕 Jul 24 '22
Crushes fingers real good if you get distracted, lol. But Tylenol laughs at it, that shit don't crush easily.
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u/sendenten RN 🍕 Jul 24 '22
laughs in multivitamin with minerals
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u/HoneyBloat RN - ICU 🍕 Jul 24 '22
My fav is my DO NOT CRUSH lipase balls that we still have to crush.
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u/jevers1 RN - ER 🍕 Jul 24 '22
This reminds me of a time I ruined a mickey peg tube because I was being a good nurse and asked for the feed tube version of protonix instead of just crushing the regular one. Those little bastard balls got stuck and then my pt coughed or something and suddenly I was in a splash zone. Luckily, I could just swap out the tubing but still, it had been a rough night and this was just the chef’s kiss to top it off.
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u/sendenten RN 🍕 Jul 24 '22
Are you talking about Protonix granules? Ugh, they are the WORST. My current facility uses liquid Protonix, it's so much easier but it fizzes a lot and only comes in a 20mL solution.
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u/Affectionate_Grape61 Travel RN Jul 25 '22
Protonix granules must be mixed with apple juice. The balls kinda melt down and you can push it into the tube with no prob.
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u/RabidWench RN - CVICU Jul 25 '22
I hate them bc you have to dissolve in apple juice to get them to go down properly. Otherwise they just sit there mocking you.
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u/North_Ad_4136 Jul 25 '22
The only iron we have on hand is enteric coated. All of my pegs have iron orders. We melt them in hot water and cool them down. Pharmacy keeps telling us that they don't provide the drops because it's otc but we can't provide them either 🤦
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u/ScarlettPlumeria RN - ICU 🍕 Jul 24 '22
Laughs in sodium tablets. The only way to get those things to break is to put them in boiling water.
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u/StarGaurdianBard BSN, RN 🍕 Jul 25 '22
I swear to God the silent knight is the only thing that can crush my hospitals 3mg melatonin though. Literally gave myself carpal tunnel trying to use a hand crusher on those.
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u/RN1991NY Jul 24 '22
Ours got taken away because of Joint Commission. Apparently they asked someone how it’s cleaned between uses and they didn’t have the right answer. You’ll miss it when it’s gone.
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u/mari815 Jul 24 '22
So they took it away? All they needed to do was send out education on how to clean it. That would have satisfied the joint commission
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u/RN1991NY Jul 24 '22
Yes. Now we get cheap plastic individual pill crushers that we have to request from pharmacy. They’re so wasteful and break all the time. Ugh.
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u/ToughNarwhal7 RN - Oncology 🍕 Jul 24 '22
I HATE our plastic pill crushers! I always lusted after a Silent Knight (only our rehab unit gets one 😭), but now this thread makes me wonder if they're all that great!
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u/Retalihaitian RN - ER 🍕 Jul 25 '22
I loved the silent knight. I always used paper medicine cups instead of the plastic sleeves, the crushed pills don’t stick to them.
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u/Juniperq BSN, RN 🍕 Jul 24 '22
They’re the worst!!! I have to switch between the pill splitter and the crusher ends or else I will not be able to crush the amlodipine. I miss the silent knights😭
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Jul 24 '22
Your hospital admin sounds so dumb I’m almost sure I know which hospital it is
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u/eeyoreocookie Pediatric RN, On a career break Jul 24 '22
“I don’t know, but I can call pharmacy and ask”
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u/Spiffinit Pharmacist Jul 25 '22
Pharmacy doesn’t know, we don’t use those. We go old school with mortar and pestle.
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u/eeyoreocookie Pediatric RN, On a career break Jul 25 '22
What the joint commission wants to hear though is that you won’t just leave it at “I don’t know.” They want to hear that you will at least ask around and find the answer. At least this is what my management team has suggested to us if we ever don’t know an answer to a JC question.
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u/Spiffinit Pharmacist Jul 25 '22
Sure. Generally speaking, however, the safest bet is to say “I will check the policies and procedures.”
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u/CrossP RN - Pediatric Psych Jul 25 '22
Well how do you clean the mortar and pestle?
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u/OrchidTostada RN - ICU 🍕 Jul 25 '22
No one cleans the Silent Knight. But what is the correct lie that admin wants us to tell TJC?
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u/heebit_the_jeeb NP 🍕 Jul 25 '22
It gets licked clean every night by the spirit of Florence Nightingale
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u/SignificantGoal4897 BSN, RN 🍕 Jul 24 '22
The not so silent knight 😂
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u/TriceratopsBites RN - CVICU 🍕 Jul 25 '22
Cue panic in all the sundowning patients because they think someone is breaking into their house
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u/slayhern MSN, CRNA Jul 24 '22
The packets are nice for crushing, but the backend of a flashlight is king for crushing pills
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u/tombuzz BSN, RN 🍕 Jul 24 '22
Wow battery smash and rock that shit . They never charge for shit anyway .
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u/p0psickle555 Dark humour is my friend Jul 24 '22
I enjoy crushing the pills with all my might during an insanely busy shift.
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u/Fair-Stranger1860 BSN, RN 🍕 Jul 24 '22
I focus all of my hate fire and anger into crushing the pills.
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u/nnill BSN, RN 🍕 Jul 24 '22
LMAO me too. I let out my anger in the med room. I slam the med drawers closed and feel so satisfied. Scared a nursing student that was following me around tho 😭
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u/SpoonAtKnifeFight Jul 24 '22
I used to use these cutesy painted rocks that hosp admin gave us because “we rocked” during an insanely stressful time. My friend clued me in that it was a top-notch pill crusher. Probably the most useful gift they ever gave us.
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u/Zxxzzzzx RN - Oncology 🍕 Jul 24 '22
Nothing beats the two spoons method
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u/SpicyBeachRN Mouth n Butt stuff RN Jul 24 '22
WHY DON’T WE JUST HAVE SPOONS TIED TO THE COUNTER????? WTF? SO MUCH CHEAPER!!
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Jul 24 '22
Big spoon doesn’t provide the same kickback payments.
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u/SpicyBeachRN Mouth n Butt stuff RN Jul 24 '22
Have I mentioned the looks my husband (works in IT) gives me if I need to crush a med for one of our animals 🤣 he’s all “I think you’ve done this before..?” And yeah, kick backs, less name recognition unless they have a stainless steel in rainbow chrome like the fancy ass scissors that I lust after? But I feel like there’s a market there!!!!!
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u/salinedrip-iV caffeine bolus stat Jul 24 '22
Care to explain? I never heard of the two spoon method 😅
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u/crabcancer PAC - The retirement unit Jul 24 '22
Put pills in one spoon bowl (section where your soup/rice) etc is. Put second spoon bowl over first.
Then either 1 - Find a nice hard surface, clean the surface and press down on second spoon bowl to crush and pulverise any and all hope those pills have.
2 - hold both spoon bowls between fingers and press.
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u/Zxxzzzzx RN - Oncology 🍕 Jul 24 '22
In the uk we put tablets in paper bun(small cupcake) cases for patients to take. So you put the tablet in the buncase then you can fold the paper and crush it between two spoons. Simple and effective and doesn't cost £100.
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u/weirdoftomorrow BSN, RN 🍕 Jul 24 '22
I don’t understand how to use one of our pill crushers, so I just pick it up and use the whole thing like a mallet. Sometimes you just gotta
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u/Julitacanchita Jul 24 '22
We have a small hammer someone bought at the dollar store that we use with the silent knight sleeves. Shhh don’t tell management.
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u/scarfknitter BSN, RN 🍕 Jul 24 '22
I took my second hammer home with me every night. Unit manager stole the first one.
My mom looked though my work bag once and asked why there was a hammer. Apparently ‘I use it to help me with the patients’ was not the best answer.
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u/phro321 Jul 24 '22 edited Jul 24 '22
Did you do the 6hr long edu on health stream exposing the safety and security feature and how to properly use the device so as to not cause harm to patients. It also explains how not to rips. Hole in the baggies and how many pills to actually use and ……. Fuck that silent shit. A stapler does a better job and is actually less noisemaker
Edit: night shift
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u/BruteeRex Custom Flair Jul 24 '22
What?! How are you using it?
The silent knight is amazing
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u/SillyBonsai BSN, RN 🍕 Jul 24 '22
I agree, I think adjusting technique is key. Depends on the med too. If you can position the pill on the edge of the plate for the first couple crushes, you should be fine.
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u/slothurknee BSN, RN 🍕 Jul 24 '22
Old silent knight = the best New silent knight = mediocre at best
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Jul 24 '22
Depends on which kind you’re using. I’ve used some that are great and some that are useless.
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Jul 24 '22 edited Jul 24 '22
We have First Crush pill crusher. Look at you plebs still using silent knight 👀
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u/Empty_Netterberg RN - ER 🍕 Jul 24 '22
It's better than using blood culture containers!
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u/_neutral_person RN - ICU 🍕 Jul 24 '22
Oof. I use my hospital provided volte phone. "Pill crusher app"
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u/Cobblestone-Villain LPN 🍕 Jul 24 '22 edited Jul 24 '22
Silent knight is honestly the best one I've used over the last 20yrs and I crush A LOT of pills in LTC. For the record I've used the metal hinge ones where you need a paper med cup to cover the original that contains the pills, a hammer and the rechargeable ones that are absolutely useless and don't crush worth shit.
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u/Squildo Pally O’Tiv Jul 24 '22 edited Jul 24 '22
It only sucks if you’re one of those people that repeatedly slam it like a judge’s gavel
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u/SmallRests RN - Psych/Mental Health 🍕 Jul 24 '22
exactly i think that’s what most of these people are doing. there’s a technique to it and actually the slower you go the better they crush
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u/whitepawn23 RN 🍕 Jul 24 '22
Pills break the baggies every time and make a mess. Get the twist top crusher.
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u/whotaketh RN - ED/ICU :table_flip: Jul 24 '22
Just please, please don't crush potassium
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u/Hutchoman87 Neuroscience RN Jul 24 '22
It’s ok. Doesn’t pulverize the best for NG/PEG so I just finish it off in the mortar/pestle. But works fine for smashing meds to put in the food
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u/AlabasterPelican LPN 🍕 Jul 25 '22
Mortar and pestle‽ I'm soooo fucking jealous! The silent knight usually does the to trick, but I recently had a patient for about 2 weeks that would only take their meds if they couldn't feel them in whatever I mixed them in (oddly the taste was apparently not an issue 🤣). For about a week it took me around 30 minutes to get their meds ready using the silent knight to get them crushed individually, then taking the pouch, taping it closed, laying it on a textured cutting board and grinding the shit out of them with a hard spatula. I eventually gave up and went and bought a pill grinder and it did better by itself than with the silent knight.
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u/peach_1995 RN 🍕 Jul 24 '22
I mean, we have something that we literally use to hammer the meds into a powder. Can’t get much worse than that 😅
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u/jiij510 RN, PHN Jul 24 '22
The pill crusher that comes with the Macy catheter is the best I've used. I wish they'd sell them separately.
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u/wardiamond RPN - LTC Jul 24 '22
We have the silent knight and an electric one. The electric one makes the silent knight look amazing, as it is loud as all fuck and just kinda breaks the pills into smaller chunks.
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u/beanieboo970 Jul 24 '22
I do like taking my anger out on the pills. But we never have enough bags for the pills.
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u/mikealex099 RN - Med/Surg 🍕 Jul 24 '22
Agreed. Found that utilizing my time spent slamming my head against the wall works well to both crush the meds and attempt to kill enough brain cells to understand the sheer amount of ignorance that can come out of peoples’ mouth holes.
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u/eldubrn Jul 24 '22
Midodrine is damn near indestructible.
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u/osuzu RN - ER 🍕 Jul 24 '22
It can dissolve in water, no need to crush it!
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u/cl3v3r6irL RN - Retired 🍕 Jul 24 '22
this. *and why do i have to crush meds, pharmacy. just give them to me as suspensions/liquids. it says NPO so it is going through a tube.
LI Q U I D *
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u/rharvey8090 CRNA Jul 24 '22
The new version of the Silent Knight is awesome. The old version sucks sweaty balls. My unit has both.
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u/SpicyBeachRN Mouth n Butt stuff RN Jul 24 '22
I have pretty good luck with it! I even surprised my preceptor!!
My method is to take only a couple of pills, space them from each other, insert into the business end, crush slowly, take a look at results - spread things out, repeat x 1 for each baggie. Probably too much thought out into it.
But then I see other people cram 6 pills in one baggie and just keep slamming it shut wondering why it doesn’t work!
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u/_neutral_person RN - ICU 🍕 Jul 24 '22
I have to give 20 pills per person. No way im doing one at a time with the silent knight. Not to mention the bag degrades over time.
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u/nursejoy9876 BSN, RN 🍕 Jul 24 '22
During our orientation, they told us to use separate bags for each med and to crush them individually. All of the new hires looked at each other and laughed. Someone bravely asked "so what if a patient has 20+ meds?"
The educator was like yeah that's why you have to be on top of your time management. Lol.
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u/SpicyBeachRN Mouth n Butt stuff RN Jul 24 '22
How are educators so far out of touch? They have no nurse hacks!!
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u/nursejoy9876 BSN, RN 🍕 Jul 24 '22
I think it's "policy" because crushing all meds together is compounding which isn't within our scope of practice. Only pharmacists can compound. At least, that's what my pharmacist friend told me.
But also...the policy is not realistic :(
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u/SpicyBeachRN Mouth n Butt stuff RN Jul 24 '22
Can’t say I’ve seen anyone do it different - not that it’s right - but I haven’t seen different.
Is proper procedure to crush each individually, flush with 30 cc/mL, then next tab? Rinse, repeat?
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u/lilsassyrn BSN, RN 🍕 Jul 24 '22
Yeah, the educators I’ve met haven’t done an actual patient assignment in years.
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u/SpicyBeachRN Mouth n Butt stuff RN Jul 24 '22 edited Jul 24 '22
Well okay yeah… and my peeps with a peg, I run my ass in their rooms before crushing their shit and say, “yo, I’m crushing your pills. List includes x, y, z, l, m, n, o, p, a, b, e. And I got your liquid gaba, liquid roxy, and prob IV antibiotic. And I’ll juice your belly with with like 120 mL of tap water. You cool? You not willing to take any of those?” Then I pull all meds, and crush a couple at a time, dump them into a pee cup as I go, grab my crap including all wrappers, back to the patient room. Usually I juice the pee cup with any liquid meds too and use the 60 mL syringe to the pee cup, suck it up, keep flushing out pee cup to get all meds and flushing peg. Still too much? I feel like it doesn’t take that long
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u/_neutral_person RN - ICU 🍕 Jul 24 '22
It clogs the NGT. Even if you do singles. The sides of the sk leave flakes.
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u/Hockeygirl420 RN - ER 🍕 Jul 24 '22
Look at the TikTok method! to crush pills, takes about 5 seconds. Game changer for me when I saw it
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u/Ocdrn1981 RN 🍕 Jul 24 '22
I open nicotine patches with my teeth.. in secret 🤫 bc I can never find a pair of scissors ✂️ (in psych)
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u/echk0w9 Jul 24 '22
I used to want a dark grey-blue colored Camaro with a white stripe called the silent knight…
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u/Medical-Funny-301 LPN 🍕 Jul 24 '22
I can't stand the Silent Knight. It works OK for 1 or 2 pills but most of my pts get at least 5-10. And to to get them crushed enough for a G-tube is next to impossible, esp G/J-tubes which clog constantly. I've tried violently slamming it shut and gently and slowly closing it. It still sucks. And the plastic bags degenerate and leak pill powder everywhere.
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u/Mixinmetoasties RN - ICU 🍕 Jul 25 '22
Also, fuck manufacturers who have the pill perforation right in the middle of the barcode.
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u/BirryMays Jul 25 '22
The little beads from inside Duloxetine capsules will never fit through a feeding tube no matter how hard you try
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u/nursekitty22 BSN, RN 🍕 Jul 25 '22
That’s because you’re not angry enough. Give it a few more years
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u/eilonwe BSN, RN 🍕 Jul 25 '22
I actually kind of liked the silent knight pill crusher. I would have sold a kidney to give my stepwitch one. That b$$ch would make herself gag on a single sudafed. So she had to crush every with a meat mallet like she was a homophobe trying to beat the gay away. Even now in her 70’s all her have to be liquid or crushable.
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u/ad_astra32 CVICU RN 🍕 Jul 24 '22
Not gonna lie, sometimes in my frustration when it didn’t do the job I’ll use whatever to crush the remainder. Phone, in a draw open and closing it on the pill baggy, whatever gets the job done.
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u/Commander_x RN - ER 🍕 Jul 24 '22
Put your pill in a 10ml syringe add 2 ml of water place thumb or cap over end and pull the plunger back and release.
Easiest way to crush pills I have ever used
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u/Apeiron_8 Jul 24 '22
It’s not bad actually, just really cumbersome to use when the old red pill crushers you could just twist down did the trick.
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u/bouwchickawow RN - IMCU Jul 24 '22
The metal one doesn’t imo but the plastic one u can just chuck out the window
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u/ladywyyn LPN 🍕 Jul 24 '22
Two paper cups and the rounded end of a highlighter cap. Works like a mortar and pestle. The Silent Knight is neither silent, nor knightly.
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u/Aknagtehlriicnae RN - NICU 🍕 Jul 24 '22
Idk I hate the disposable twisty pill crushers much more. You could only do one or two pills at a time max
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u/fuzzyberiah RN - Med/Surg 🍕 Jul 24 '22
I like the silent knight just fine tbh. Only issue I’ve seen is the rubber stop that makes it “silent” breaks down and then you’re back to slamming metal on metal like the old days. I’ve definitely had metal crushers in the past that I’ve only used by picking them up and bashing the pills.
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u/1bunchofbananas LPN 🍕 Jul 25 '22
My work spent $400 on a new one and it's worse than the old ones ffs
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u/NurseDiesel62 RN - Hospice Jul 25 '22
I actually had an instructor STEP ON THE PILL CRUSHER to help it crush the meds. She's also the one who brought mirrors to a lecture about female Foley insertion. What a wack job she was.
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u/Jinn71 Jul 25 '22
Get hot water from the pantry and dissolve the meds while you’re doing some other small task
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u/Sassysewer RN 🍕 Jul 25 '22
We didn't have pull crushers when I first started. They had little hammers all over. That would go missing. So we used the wall mounted phone handsets. They were made in the 60's I am sure and frackin indestructible. They were not silent
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u/NesCie0617 Jul 25 '22
Crushing medications like oyster cal with it is hella annoying, specially when it’s mixed with acetaminophen and other rock drugs.
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u/GeneralButtNaked84 RN - ICU 🍕 Jul 25 '22
I use a saline syringe sometimes. The little white cap makes smashing super easy. Also, If you put the pills in one of the plastic sleeves, take a few more empty ones and put them behind - which will make it more dense and tighter in the pill crusher
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Jul 25 '22
When we sent patients home with feeding tubes I always tell them to use a ziplock baggie and a rolling pin, then wonder why I don’t just bring my own rolling pin to work
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Jul 25 '22
Hot water from the coffee machine will fix any crushing issues. Just temper it with cold before you let it rip.
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Jul 24 '22
If you take one pill per Silent Knight sleeve and crush them, they do a somewhat passable job. I think the SK manufacturer made their product that way so you have to keep buying their fancy sleeves. Sort of like the glucometer manufacturers with their proprietary strips, or IV pump tubing, or razor blades, or hearing aid batteries.
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u/aleksa-p RN - ER 🍕 Jul 24 '22
Hey, it’s better than the mortar and pestle my unit still has. I tried the syringe technique for the first time the other day, though, and had too much fun with it
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u/_neutral_person RN - ICU 🍕 Jul 24 '22
I just tried it. Worked well the first time. Second time the syringe explodes. BD.
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u/huebnera214 RN - Geriatrics 🍕 Jul 24 '22
I call mine ‘stress relief’ for how aggressive I have to be to make it crush things well.
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u/Due-Pianist-5915 RN - ICU 🍕 Jul 24 '22
Hemostats work. Not the shitty plastic ones, the real ones.
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u/ruthh-r RN 🍕 Jul 24 '22
Best pill crusher is two metal spoons. Put the pill/pills in the bowl of one and grind them up with the back of the other. I've used many different commercial pill crushers but I always go back to my trusty spoons.
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u/[deleted] Jul 24 '22
The old school nurse I work with puts the meds on the counter and smashes them with the pill crusher, cave man style.