Role of pharmacists in providing parenteral nutrition support: current insights and future directions

Abstract

BackgroundParenteral nutrition (PN) therapy is a complex and critical therapy that requires special clinical knowledge, skills, and practice experience to avoid errors in prescribing, compounding, and clinical management of patients. Pharmacists with adequate clinical training and expertise in PN therapy can have pivotal role in the care of patients receiving PN therapy.ObjectiveThe aim of this systematic review was to describe and evaluate the different roles of pharmacists and their provided services related to PN therapy.Materials and methodsA comprehensive systematic literature review on the topic was conducted via PubMed database using several keywords related to the topic (from 1975 to 2017). Additional resources included the standards of practice and clinical guidelines from recognized organizations such as the American Society for Parenteral and Enteral Nutrition (ASPEN) and the American Society of Health-System Pharmacists (ASHP).ResultsPharmacists have diverse roles in relation to PN therapy including the following: the assessment of patients’ nutritional needs; the design, compounding, dispensing, and quality management of PN formulations; monitoring patients’ response to PN therapy; supervision of home parenteral nutrition (HPN) programs; education of patients, caregivers, and other health care professionals on nutrition support and conducting PN-related research and quality improvement activities. These services seem to be variable across clinical settings and among different countries depending on the practice environment and pharmacists’ clinical practice in these settings. However, each of these practice domains helps to support the delivery of safe and effective PN therapy to patients.ConclusionPharmacists have been actively participating in providing PN-related services to patients. To fulfill the requirements of their essential role in this area of practice, pharmacists need adequate educational preparation and clinical training on nutrition support. Empowerment of pharmacists to assume a stronger leadership role in this dimension of pharmacy practice will enhance the quality of care provided to patients receiving PN therapy and improve PN services.

Perceptions and Attitudes Towards Clinical Pharmacy Services and Their Impact on The Management of Cancer in Taif, Saudi Arabia

“…The present study found that only about half of the students heard about the clinical pharmacy in their institutions during their study period. This may be due to absence of patient-oriented PharmD programs (Baniasadi et al, 2014;Bryant et al, 2009;Katoue, 2018;Stemer and Lemmens-Gruber, 2011). Also, a large proportion of the students agreed that HCPs will accept the pharmacists to provide additional services within the framework of clinical pharmacy.…”

Controlling Risks in the Compounding Process of Individually Formulated Parenteral Nutrition: Use of the FMECA Method (Failure modes, effects, and Criticality Analysis)

“…When the gastrointestinal tract is dysfunctional or inaccessible (cannot initiate enteral nutrition, necrotizing enterocolitis, gastrostomy), parenteral nutrition (PN) is used. PN formulations are complex admixtures that consist of multiple components, including both macronutrients (amino acids, lipids and dextrose) and micronutrients (electrolytes, vitamins, and trace elements) [3]. The importance of nutritional support for preterm neonatal outcomes is becoming increasingly accepted [4].…”

The Clinical Outcomes of Pharmacist Interventions in Total Parenteral Nutrition services in Riyadh City, Saudi Arabia

“…Based on best of our knowledge; there is no study occurred at Saudi Arabia, the Gulf, or Middle Eastern countries. [9] Therefore, the goal of this study was to explore the impact of the clinical outcome of pharmacist intervention through Total Parenteral nutrients at the public hospital in Riyadh city, Kingdom of Saudi Arabia.…”