Impact of Implementation of the American Society for Parenteral and Enteral Nutrition Model for Parenteral Nutrition Order Writing and Review on Competency, Attitudes, and Perceptions

Abstract

Background: The American Society for Parenteral and Enteral Nutrition (ASPEN) parenteral nutrition (PN) safety consensus recommendations advise a comprehensive education program and competency assessment for all healthcare professionals involved in the care of patients receiving PN. The ASPEN-model papers provide guidance for designing PN competencies for prescribers, pharmacists, and pharmacy technicians. The purpose of this research was to evaluate the impact of a comprehensive educational program that aligns with the ASPEN model on PN competency, attitudes, and perceptions in a multidisciplinary healthcare professional audience. Methods: Dietitians, pharmacists, and physicians attended a 3-hour ASPEN model-based educational program focused on PN order writing and review. Matched preeducation and posteducation competency assessments were completed by attendees. Attitudes and perceptions were also assessed before and after the educational program using 5-point Likert scales. Results: Ninety-seven subjects were included in the analysis. The majority of attendees were dietitians (53.6%), followed by pharmacists (45.4%). Overall, multidisciplinary competency assessment scores improved by an average of 12.6% (preassessment average of 62.7%, postassessment average of 75.3%, P < 0.0001). Nine out of 10 statements regarding PN attitudes and perceptions significantly improved on the 5-point Likert scales (P < 0.05). Conclusion: A comprehensive PN educational program in alignment with the ASPEN model positively impacted multidisciplinary healthcare professional PN competency, attitudes, and perceptions. To optimize patient safety, local organizations and institutions should implement formalized training as outlined by the ASPEN model for healthcare professionals involved in the care of patients receiving PN. (Nutr Clin Pract. 2019;34:597-605)

The feasibility of electromagnetic sensing aided post pyloric feeding tube placement (CORTRAK) in patients with thrombocytopenia with or without anticoagulation on the intensive care unit

“…16,24 Preexisting epistaxis was considered as contraindication in those studies. 25 In the light of the high-risk constellation for severe bleeding events in our cohort, the risk of severe bleeding was negligible to little when using CEAS for establishing nasojejunal EN. Clearly, a relatively high overall rate of epistaxis was noted in these high-risk patients but at a low grade (CTCAE grade 1, 37.5%).…”

“…Furthermore, transportation of ICU patients to another department for the intervention may compromise patients safety, ultimately resulting in more operation time be required or postponement of the intervention. 6,24,25 With this analysis, we are the first to show that the use of electromagnetic-guided CEAS for PP feeding tube placement is feasible, safe, and effective in patients with a low platelet count and receiving therapeutic anticoagulation in the ICU. Beside such a highly selected study population, CEAS has proven efficacy and safety in numerous studies when performed by an experienced operator.…”

The Role of a Simulation-Based Activity on Student Perceptions of Parenteral Nutrition Education

“…The average score for nutrition support was 3.05 out of a maximum of 5, which was lower than their biostatistics and pharmacokinetics scores [6]. In another study, only 39.5% of the pharmacists at the beginning of a continuing education course indicated that they felt comfortable calculating protein and caloric requirements for patients on PN [7].…”

“…The literature suggests that pharmacists may not be adequately prepared to provide direct patient care in the area of nutrition support [6,7]. For example, in a study by Mutz et al, pharmacy residency directors were asked to evaluate their postgraduate year one (PGY1) residents' clinical knowledge [6].…”

Call to action: The need for enhanced nutrition support education and training in pharmacy schools and postgraduate programs

“…According to a survey sent to ASHP‐accredited pharmacy postgraduate year one (PGY1) residency directors in the United States, residents scored the lowest in their clinical knowledge of nutrition compared to all other domains, including pharmacokinetics and biostatistics 13 . Furthermore, approximately 37% of pharmacists reported a lack of confidence in calculating energy and protein needs of PN patients 14 . In addition, a survey conducted by Sheridan et al evaluated pharmacists' education and responsibilities in PN and was sent to members of the American College of Clinical Pharmacy (ACCP) Critical Care Practice and Research Network 15 .…”