Pharmacists are on the frontlines of healthcare as advocates for their patients and are among the most accessible members of the healthcare team.1 In fact, according to investigators in a nationwide geographic information systems analysis, “nearly 90% of Americans live within five miles of a community pharmacy.”2
The face of neighborhood healthcare
Patients come to know and trust their local pharmacist with their health and medication management. That’s why pharmacies are often recognized as “the face of neighborhood healthcare.”3 But pharmacists are also critical healthcare members in hospitals, community health centers, and long-term care facilities. Let’s take a “behind-the-scenes” look at the many roles these pharmacists play in caring for their patients.
Pharmacists in clinical practice are tasked with verifying and dispensing medication orders, recommending appropriate dose adjustments, and communicating with other members of the healthcare team to help ensure patient safety. And some are involved in the management of clinical nutrition, including parenteral nutrition (PN). In order to prepare and compound PN, pharmacists must undergo special training that includes competency assessments and the completion of a learning program associated with PN ordering and preparation.4 Some pharmacists become Board Certified Nutrition Support Pharmacists (BCNSP) and must become recertified every seven years by passing the BPS Nutrition Support Pharmacy Recertification Exam or by earning 100 hours of continuing education credit through Purdue University College of Pharmacy.5
Pharmacists in clinical practice are tasked with verifying and dispensing medication orders, recommending appropriate dose adjustments, and communicating with other members of the healthcare team to help ensure patient safety.
An integral part of the multidisciplinary nutrition care team
“Pharmacists with adequate clinical training and expertise in PN therapy can have pivotal roles in the care of patients receiving PN therapy.”6 They’re “an integral part of the multidisciplinary nutrition care team.”4 They play a central role in the final stages of the PN process and are responsible for reviewing, transcribing, preparing, and compounding PN.4,7 PN is compounded manually or with the use of an automated compounding device (ACD) using sterile compounding techniques.4,7 Manual compounding is often labor-intensive and requires multiple manipulations of infusion equipment that can contaminate the final admixture.8 Though not guaranteed to be error-free, using an ACD is associated with improved compounding accuracy and reduced contamination.8 Beyond these responsibilities, a pharmacist’s roles can also include monitoring patients’ response to PN therapy; supervising home parenteral nutrition (HPN) programs; educating patients, caregivers, and other healthcare professionals on nutrition support; and conducting PN-related research and quality improvement activities.6
“The ultimate goal is to reduce PN-related medication errors”4
PN is a complex, high-alert medication with the potential to cause errors that can lead to patient harm.9-11 The gap analysis by Boullata et al estimated that monthly PN-related medication errors were reported by nearly 53% of respondents; however, 44% of respondents reported not knowing about these errors or that their organization doesn’t track these errors.11 Further, 58% did not know where in the process errors may be happening.11 That’s why pharmacists are crucial to the PN process. In their review of the PN prescription, they can prevent errors by ensuring appropriate dosing, stability, and compatibility of PN ingredients.
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