The goal of the Nutrition Support rotation is to allow the resident to become a specialist in the maintenance and/or restoration of optimal nutritional status in patients. The resident will provide customized nutrition either enterally or parenterally according to the needs of the patient and will assume complete responsibility for patient care.
The Nutrition Support Rotation will provide the resident the opportunity to develop an understanding of providing appropriate nutrition for hospitalized patients including adult, pediatrics, and neonatal populations. The resident will assess patients' nutritional goals and needs and provide pharmaceutical care as described below:
- Collecting and organizing patient-specific information
- Determining the presence of medication-therapy problems
- Summarizing the patient's nutritional requirements based on patient-specific parameters
- Developing the appropriate monitoring parameters to assess the effectiveness of the nutritional plan
- Evaluate and modify the nutritional care plan using monitoring parameters
- Patients with the following conditions are commonly encountered: COPD, diabetes, renal failure, short gut syndrome, HIV, hyperemesis gravidarum, necrotizing enterocolitis, cancer chemotherapy, Crohn's disease/ulcerative colitis, pancreatitis, cardiovascular disease, extremely premature neonates.
- All drug therapy used will be monitored for therapeutic effect and adverse events.
- Evaluate appropriateness of specialized nutritional needs:
- formulary enteral nutrition products
- describe the different enteral formulas with respect to differences in concentration and composition for specific disease states
- spend one day rounding with nutrition support dietitian
- common enteral - drug interactions.
- enteral access tubing and feeding methods
- Develop a parenteral nutrition formula with respect to age, disease state, injury, organ failure, and other specialized needs.
- Be familiar with parenteral nutrition preparation techniques and components
- Recommend conversion from intravenous to oral therapy when appropriate.
- Make recommendations for appropriate nutritional formulations for patients with renal or hepatic insufficiency.
- Evaluate patient's fluid requirements and review patient's daily intake and output record as appropriate.
- Monitor patient-specific therapeutic regimens daily. Focusing on appropriate fat, carbohydrate, protein, vitamin and mineral requirements, and electrolyte needs.
- Make recommendations as appropriate to correct abnormal glucose levels and be familiar with insulin requirements related to specialized nutrition support.
- Be familiar with venous access sites and tubings for peripheral and central parenteral nutrition.
- Evaluate for drug/nutrient interactions, drug duplication, and prevent incompatibilities.
- Demonstrate influence in helping ensure adherence to medication use policies, such as non-formulary conversions and criteria for use of specific therapies.
- Consult service
- Utilize all above skills to develop a parenteral nutrition formula that is safe and appropriate.
- Provide for nutritional needs using patient - specific macronutrients and micronutrients.
- Monitor patients daily to provide metabolic homeostasis until transition to enteral feeding.
- Transition to home care
- Develop cyclic parenteral nutrition regimen for transition to home or long-term care.
- Communicate with home-care as needed to safely transition patients to outpatient care, or from outpatient to inpatient care.
- Required hours 7 am to 4 pm. The times may vary based on patient care and team needs.
- Document therapeutic interventions in the clinical decision support software, Theradoc©
- Participate in adverse drug reaction reporting.
- Provide nursing in-services on drug related topics as needed or requested.
- Provide drug information to patients or caregivers as requested.
- Assist in precepting pharmacy students and attend student presentations.
- Effectively communicate with physicians, nurses and other members of the health care team when discussing nutrition therapy.
- Utilize automated compounder and accompanying software.
James Nash, B.S. Pharm