CP-177 Individual parenteral nutrition: pharmacist work as a multidisciplinary team member

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Abstract

Background

Parenteral nutrition (PN) provide nutrients required for any pathology. However, it is a technique with complications and represents a substantial health care burden and a considerable economic cost.

Purpose

To describe the contribution of a pharmacist in the prescription of PN and to analyse the degree of acceptance by the prescribing doctor.

Material and methods

This was a prospective study in patients with requiring total parenteral nutrition support from March to April 2016 in a tertiary care hospital. The prescriptions included were received via the form ‘treatment parenteral nutrition’ from the medical record programme Selene and were managed through the parenteral nutrition programme Kabisoft. A database was created with: demographical data (age and sex), type (individualised adult diet, notarised diet, marketed tricameral diet or individualised paediatric diet), service of the prescribing doctor, modifications of grams of nitrogen (N), grams of lipids, grams of carbohydrates (HC), sodium content (Na), potassium (K), calcium (Ca), magnesium (Mg), phosphate (P), chlorine (Cl), acetate (Ac), supply of vitamins, trace elements, insulin intake, grams of glutamine, and volume and acceptance of the amendment. Modifications were consulted via telephone with the prescribing doctor.

Results

There were 633 prescriptions for PN, corresponding to 69 patients, and in 39 (6.2%) at least one modification was required. The prescriptions requiring PN modification belonged to 18 patients with a median age of 54 years (interquartile range 38.5–68), 66.7% men. Prescriptions for PN that were modified corresponded to 59.0% in intensive care and 33.3% in endocrinology. The rest belonged to paediatrics and the neonatal unit. 32 (82.0%) of the prescriptions for PNP were individualised for adults, 2 (5.1%) were protocolised for patients with renal failure, 1 (2.6%) was protocolised for degree of stress, 3 (7.7%) were paediatric PN and 1 (2.6%) was a marketed tricameral PN. A total of 69 amendments were made. Distribution: 23.2% (lipid), 8.8% (HC), 15.9% (volume), 8.7% (N), 4.3% (glutamine) and 4.3% (insulin). Both vitamins and trace elements corresponded to 2.9% of the changes. Changes in electrolytes were distributed as follows: 8.7% (Na), 2.9% (Ca and P) and 1.4% (Mg, Cl and Ac). No changes were made in the contributions of K. All amendments were accepted by the prescribing doctor.

Conclusion

The largest number of modifications corresponded with grams of lipids, N, HC and volume. The PN prescribed by the intensive care unit needed more changes. Knowing that the ratio of non-protein calories per gram of N represents an objective and quantifiable amount for the use of protein in metabolism, it is important to highlight the role of the pharmacist in controlling this ratio, especially in critically ill patients, being one of the parameters that mostly goes unnoticed by prescribing doctors. Integration of a pharmacist in the prescription of PN provides more security and increases the adequacy of the PN for the patient’s needs.

Conclusion

No conflict of interest

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