Nutrition Support Pharmacy Services in Critically Ill Cancer Patients Admitted to Intensive Care Units: A Retrospective Analysis of Clinical Pharmacists’ Interventions
DOI:
https://doi.org/10.35516/jjps.v17i4.2540Keywords:
Clinical pharmacy services, nutrition support pharmacy, anticancer agents, critical careAbstract
Objectives: This study aimed to analyze clinical pharmacists' interventions in managing nutrition support therapy in critically ill cancer patients admitted to intensive care units.
Methods: A retrospective analysis of 9949 electronically reported clinical pharmacist interventions of patients admitted to ICU from January 2020 to December 2022 was conducted. All patients’ records with clinical pharmacists’ interventions related to nutrition support therapy in ICU cancer patients were included and analyzed.
Results: The number of interventions for managing nutrition support therapy was 95 (0.95 %). Parenteral nutrition (n = 83, 87.4 %) was the most frequently used class of nutrition support therapies. The evaluation, adjustment, and monitoring of total parenteral nutrition (n = 75, 78.9 %) was the most frequent intervention of clinical pharmacists. The acceptance rate of clinical pharmacists' interventions in nutrition support therapy by physicians was 100 %.
Conclusion: Clinical pharmacists have a role in managing specialized nutrition support therapy in critically ill cancer patients. The prevailing clinical pharmacists’ intervention was evaluating, adjusting, and monitoring total parenteral nutrition. More studies are needed to investigate the barriers that prevent the application of nutrition support pharmacy services in Jordan and to find the impact of these services on patient outcomes.
References
Definition of Clinical Pharmacy ACCP. Available at: https://www.accp.com/stunet/compass/definition.aspx (Accessed: 01 March 2024).
BPS specialties, Board of Pharmacy Specialties. 2024. Available at: https://bpsweb.org/bps-specialties/
ASPEN, What Is Nutrition Support Therapy? Nutritioncare.org. 2024. Available from:
https://www.nutritioncare.org/About_Clinical_Nutrition/What_is_Nutrition_Support_
ASPEN | What Is a Nutrition Support Professional [Internet]. Nutritioncare.org. 2024. Available from: https://www.nutritioncare.org/what-is-a-NSP/
McClave S., DiBaise J., Mullin G. and Martindale R. ACG Clinical Guideline: Nutrition Therapy in the Adult Hospitalized Patient. American Journal of Gastroenterology. 2016; 111(3):315-334. DOI: https://doi.org/10.1038/ajg.2016.28
American Society Health-System Pharmacists. ASHP guidelines on the safe use of automated compounding devices for the preparation of parenteral nutrition admixtures. Am J Health-Syst Pharm. 2000; 57:1343—8 DOI: https://doi.org/10.1093/ajhp/57.14.1343
ASPEN Board of Directors and the clinical guidelines task force. Guidelines for the use of parenteral and enteral nutrition in adult and paediatric patients. J Parenter Enteral Nutr. 2002; 26:1SA—138SA DOI: https://doi.org/10.1177/0148607102026001011
Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient JPEN. 2016; 2(40):159 – 211.
ASPEN Clinical Guidelines: Parenteral Nutrition Ordering, Order Review, Compounding, Labeling, and Dispensing JPEN. 2014; 3(38):334–377. DOI: https://doi.org/10.1177/0148607114521833
Yalcin S., Gumus M., Oksuzoglu B., Ozdemir F., Evrensel T., Sarioglu A., et al. Nutritional Aspect of Cancer Care in Medical Oncology Patients. Clinical Therapeutics. 2019; 41(11):2382-2396. DOI: https://doi.org/10.1016/j.clinthera.2019.09.006
Sioson M., Martindale R., Abayadeera A., Abouchaleh N., Aditianingsih D., Bhurayanontachai R., et al. Nutrition therapy for critically ill patients across the Asia–Pacific and Middle East regions: A consensus statement. Clinical Nutrition ESPEN. 2018; 24:156-164. DOI: https://doi.org/10.1016/j.clnesp.2017.11.008
Value of Nutrition Support Therapy: Impact on Clinical and Economic Outcomes in the United States. Journal of Parenteral and Enteral Nutrition. 2020; 44(3):395-406. DOI: https://doi.org/10.1002/jpen.1768
Rollins C., Durfee S.M., Holcombe B.J., et al. Standards of practice for nutrition support pharmacists. Nutr Clin Pract. 2008; 23(2):189—94. DOI: https://doi.org/10.1177/0884533608316164
Holcombe B.J., Thorn D.B., Strausburg K.M., et al. Analysis of the practice of nutrition support pharmacy specialists. Pharmacotherapy. 15(6):806—13. DOI: https://doi.org/10.1002/j.1875-9114.1995.tb02903.x
Ukleja A., Freeman K.L., Gilbert K., et al. Standards for nutrition support: adult hospitalized patients. Nutr Clin Pract. 2010; 25(4):403—14. DOI: https://doi.org/10.1177/0884533610374200
Pharmaceutical compounding: sterile preparations, the United States pharmacopoeia, 30th rev, and the National Formulary. 25th ed. Rockville MD: The United States Pharmacopeial Convention. 2007; 334—51
Hilgarth H., Wichmann D., Baehr M., Kluge S. and Langebrake C. Clinical pharmacy services in critical care: results of an observational study comparing ward-based with remote pharmacy services. Int J Clin Pharm. 2023; 45(4):847-856.
doi:10.1007/s11096-023-01559-z DOI: https://doi.org/10.1007/s11096-023-01559-z
Borthwick M. The role of the pharmacist in the intensive care unit. J Intensive Care Soc. 2019; 20(2):161-164. doi:10.1177/1751143718769043 DOI: https://doi.org/10.1177/1751143718769043
Arredondo E., Udeani G., Horseman M., Hintze T.D. and Surani S. Role of Clinical Pharmacists in Intensive Care Units. Cureus. 2021; 13(9):e17929.
doi:10.7759/cureus.17929 DOI: https://doi.org/10.7759/cureus.17929
Jurado L.V. and Steelman J.D. The role of the pharmacist in the intensive care unit. Crit Care Nurs Q. 2013; 36(4):407-414.
doi:10.1097/CNQ.0b013e3182a11057 DOI: https://doi.org/10.1097/CNQ.0b013e3182a11057
Althomali A., Altowairqi A., Alghamdi A., et al. Impact of Clinical Pharmacist Intervention on Clinical Outcomes in the Critical Care Unit, Taif City, Saudi Arabia: A Retrospective Study. Pharmacy (Basel). 2022; 10(5):108. doi:10.3390/pharmacy10050108 DOI: https://doi.org/10.3390/pharmacy10050108
Bosma B.E., van den Bemt P.M.L.A., Melief P.H.G.J., van Bommel J., Tan S.S. and Hunfeld N.G.M. Pharmacist interventions during patient rounds in two intensive care units: Clinical and financial impact. Neth J Med. 2018; 76(3):115-124.
Fideles G.M., de Alcântara-Neto J.M., Peixoto Júnior A.A., et al. Pharmacist recommendations in an intensive care unit: three-year clinical activities. Rev Bras Ter Intensiva. 2015; 27(2):149-154. doi:10.5935/0103-507X.20150026 DOI: https://doi.org/10.5935/0103-507X.20150026
Muñoz-Pichuante D. and Villa-Zapata L. Benefit of Incorporating Clinical Pharmacists in an Adult Intensive Care Unit: A Cost-saving Study. J Clin Pharm Ther. 2020; 45(5):1127-1133. doi:10.1111/jcpt.13195 DOI: https://doi.org/10.1111/jcpt.13195
Al Dali S., Al-Badriyeh D., Gulied A., et al. Characteristics of the clinical pharmacist interventions at the National Center for Cancer Care and Research Hospital in Qatar. Journal of Oncology Pharmacy Practice. 2023; 0(0).
doi:10.1177/10781552231187305 DOI: https://doi.org/10.1177/10781552231187305
Alqassieh R., Odeh M., and Jirjees F. Intraoperative Insulin Infusion Regimen versus Insulin Bolus Regimen for Glucose Management during CABG Surgery: A Randomized Clinical Trial. Jordan Journal of Pharmaceutical Sciences. 2023; 16(3):487-498. https://doi.org/10.35516/jjps.v16i3.708 DOI: https://doi.org/10.35516/jjps.v16i3.708
Daghash R., Al-Saaideh M. A. and Itani R. Evaluation of pharmacotherapy standards during pregnancy among Jordanian pharmacy Colleges graduates. Jordan Journal of Pharmaceutical Sciences. 2023; 16(3):607–620. https://doi.org/10.35516/jjps.v16i3.972 DOI: https://doi.org/10.35516/jjps.v16i3.972
Jarab A. S., Al-Qerem W., Mukattash T. L., Alqudah S. G., Abu-Zaytoun L., Al-Azayzih A., and Khdour M. Public Perception of Pharmacist’s Role during COVID-19 Outbreak in Jordan. Jordan Journal of Pharmaceutical Sciences. 2022; 15(3):365–377. https://doi.org/10.35516/jjps.v15i3.410 DOI: https://doi.org/10.35516/jjps.v15i3.410
The jamovi project. jamovi. 2022; (Version 2.3) [Computer Software]. Retrieved from https://www.jamovi.org.
R Core Team. R: A Language and environment for statistical computing. 2021. (Version 4.1) [Computer software]. Retrieved from https://cran.r-project.org. (R packages retrieved from MRAN snapshot 2022-01-01).
Zhou X., Qiu F., Wan D., et al. Nutrition support for critically ill patients in China: role of the pharmacist. Asia Pac J Clin Nutr. 2019; 28(2):246-251.
doi:10.6133/apjcn.201906_28(2).0006
Katoue M.G. and Al-Taweel D. Role of the pharmacist in parenteral nutrition therapy: challenges and opportunities to implement pharmaceutical care in Kuwait. Pharm Pract (Granada). 2016; 14(2):680.
doi:10.18549/PharmPract.2016.02.680 DOI: https://doi.org/10.18549/PharmPract.2016.02.680
Giancarelli A. and Davanos E. Evaluation of Nutrition Support Pharmacist Interventions. Journal of Parenteral and Enteral Nutrition. 2014; 39(4): 476-481. DOI: https://doi.org/10.1177/0148607114551025
Salman G. and Boullata J.I. The Value of Nutrition Support Pharmacist Interventions. Crit Care Explor. 2022; 10(2):e0650. doi:10.1097/CCE.0000000000000650. PMID: 35211684; PMCID: PMC8860336. DOI: https://doi.org/10.1097/CCE.0000000000000650
Gallagher J., Byrne S., Woods N., Lynch D. and McCarthy S. Cost-outcome description of clinical pharmacist interventions in a university teaching hospital. BMC Health Serv Res. 2014; 14:177. doi:10.1186/1472-6963-14-177 DOI: https://doi.org/10.1186/1472-6963-14-177
Hammad E.A., Qudah R.A. and Akour A.A. The impact of clinical pharmacists in improving Jordanian patients' health outcomes. Saudi Med J. 2017; 38(11):1077-1089. doi: 10.15537/smj.2017.11.21453. DOI: https://doi.org/10.15537/smj.2017.11.21453
PMID: 29114694; PMCID: PMC5767609.
Aljbouri T.M., Alkhawaldeh M.S., Abu-Rumman A.E., Hasan T.A., Khattar H.M. and Abu-Oliem A.S. Impact of clinical pharmacist on cost of drug therapy in the ICU. Saudi Pharm J. 2013; 21(4):371-374.
doi:10.1016/j.jsps.2012.12.004 DOI: https://doi.org/10.1016/j.jsps.2012.12.004
Al-azzam S.I., Shara M., Alzoubi K.H., Almahasneh F.A. and Iflaifel M.H. Implementation of clinical pharmacy services at a university hospital in Jordan. Int J Pharm Pract. 2013; 21(5):337-340. doi:10.1111/ijpp.12009 DOI: https://doi.org/10.1111/ijpp.12009
Department of Pharmacy, Department of Pharmacy | King Hussein Cancer Foundation and Center. 2024. Available at: https://www.khcc.jo/en/pharmacy







