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PS-010 Role of pharmacist in preventing Drug-Related Problems associated to prescription of total parenteral nutrition by clinical status
  1. C Cuesta-Grueso,
  2. JE Poquet-Jornet,
  3. A Munilla-Das,
  4. S Sánchez-Aranda
  1. Hospital de Denia, Pharmacy, Denia, Spain

Abstract

Background Pharmaceutical Interventions (PI) have been documented in patients with parenteral nutrition, mostly adjustments in the composition. In our hospital the physician prescribes total parenteral nutrition (TPN) by clinical status and the pharmacist decides the appropriate composition of TPN for each patient.

Purpose To describe and analyse PI and Drug-Related Problems (DRP) associated with the prescription of TPN by clinical status in a hospital with computerised medical records.

Materials and methods We prospectively recorded all PI for six months in patients prescribed TPN. The prescriptions were made by the physician in the electronic prescription system (Cerner Millennium Powerchart, version 2012.01.17) selecting an option for the patient’s clinical status (e.g. ‘low stress TPN’, ‘medium stress TPN’, etc.). The pharmacist validates the indication, assesses the patient’s nutritional status, calculates the nutritional requirements, develops a nutritional plan and decides the TNP composition.

Results During the study period 45 electronic prescriptions for TPN arrived at the Pharmacy Service. 34 patients started TPN. PI were made in 19 cases (mean 0.4 PI per patient with prescription): 11 PI (57.9%) were recommendations not to start TPN and 8 PI (42.1%) were recommendations to discontinue TPN. All recommendations were accepted and documented in the medical record. All DRP avoided were of indication (start of TPN not indicated or inadequate duration).

Conclusions PI contribute to avoiding DRP in patients with TPN. Our results show fewer PI than are documented by other authors. This is because PI do not arise in response to TPN composition, which is decided directly by the pharmacist. The greater involvement of pharmacists in prescribing decisions explains the lower number of PI.

No conflict of interest.

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