Role of the pharmacist in parenteral nutrition therapy: challenges and opportunities to implement pharmaceutical care in Kuwait
Main Article Content
Keywords
Parenteral Nutrition, Pharmacists, Professional Role, Professional Practice, Qualitative Research, Kuwait
Abstract
Background: Pharmacists can provide beneficial pharmaceutical care services to patients receiving Parenteral Nutrition (PN) therapy by working within Nutrition Support Teams (NSTs).
Objective: This study was designed to explore pharmacists’ role in PN therapy in hospitals of Kuwait, sources of PN-related information, opinions on NSTs, perceptions about the barriers to pharmaceutical care implementation and views on how to enhance their practices.
Methods: Data were collected via face-to-face semi-structured interviews with the senior Total Parenteral Nutrition (TPN) pharmacists at all the hospitals which provide TPN preparation services (six governmental hospitals and one private hospital) in Kuwait. Descriptive statistics were used to describe pharmacists’ demographic details and practice site characteristics. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.
Results: The pharmacists mainly performed technical tasks such as TPN compounding with minimal role in providing direct patient care. They used multiple different sources of TPN-related information to guide their practice. They reported positive and negative experiences with physicians depending on their practice environment. None of the hospitals had a functional NST. However, pharmacists expressed preference to work within NSTs due to the potential benefits of enhanced communication and knowledge exchange among practitioners and to improve service. Pharmacists perceived several barriers to providing pharmaceutical care including lack of reliable sources of TPN-related information, lack of a standard operating procedure for TPN across hospitals, insufficient staff, time constraints and poor communication between TPN pharmacists. To overcome these barriers, they recommended fostering pharmacists’ education on TPN, establishing national standards for TPN practices, provision of pharmacy staff, development of NSTs, enhancing TPN pharmacists’ communication and conducting TPN-research research.
Conclusion: TPN pharmacists in Kuwait are confined to performing TPN manufacturing processes. There are promising avenues for future development of their role in patient care. This can be achieved by overcoming the barriers to pharmaceutical care practice and providing pharmacists with educational opportunities to equip them with the clinical competencies needed to practise as nutrition support pharmacists with patient-centred roles.
References
2. Howard P. Practical nutritional support: working together to make it happen. Proc Nutr Soc. 2001;60(3):415-418.
3. Tucker A, Ybarra J, Bingham A, Blackmer A, Curtis C, Mattox T, Miller C, Ward C, Williams NT; Standards of Practice for Nutrition Support Pharmacists Task Force; American Society for Parenteral and Enteral Nutrition. American society for parenteral and enteral nutrition (A.S.P.E.N.) standards of practice for nutrition support pharmacists. Nutr Clin Pract. 2015;30(1):139-146. doi: 10.1177/0884533614550318
4. Greenlaw CW. Pharmacist as team leader for total parenteral nutrition therapy. Am J Hosp Pharm. 1979;36(5):648-650.
5. Allwood MC, Hardy G, Sizer T. Roles and functions of the pharmacist in the nutrition support team. Nutrition. 1996;12(1):63-64.
6. Giancarelli A, Davanos E. Evaluation of nutrition support pharmacist interventions. JPEN J Parenter Enteral Nutr. 2015;39(4):476-481. doi: 10.1177/0148607114551025
7. Zargarzadeh AH, Jacob S, Klotz RS, Khasawneh FT. Clinical pharmacists and basic scientists: do patients and physicians need this collaboration? Int J Clin Pharm. 2011;33(6):886-894. doi: 10.1007/s11096-011-9562-6
8. Mutchie KD, Smith KA, MacKay MW, Marsh C, Juluson D. Pharmacist monitoring of parenteral nutrition: clinical and cost effectiveness. Am J Hosp Pharm. 1979;36(6):785-787.
9. Dice JE, Burckart GJ, Woo JT, Helms RA. Standardized versus pharmacist-monitored individualized parenteral nutrition in low-birth-weight infants. Am J Hosp Pharm. 1981;38(10):1487-1489.
10. Mousavi M, Hayatshahi A, Sarayani A, Hadjibabaie M, Javadi M, Torkamandi H, Gholami K, Ghavamzadeh A. Impact of clinical pharmacist-based parenteral nutrition service for bone marrow transplantation patients: a randomized clinical trial. Support Care Cancer. 2013;21(12):3441-3448. doi: 10.1007/s00520-013-1920-6
11. American Society of Hospital Pharmacists. ASHP statement on pharmaceutical care. Am J Hosp Pharm. 1993; 50:1720–1723. Available at: http://www.ashp.org/doclibrary/bestpractices/orgstpharmcare.aspx
12. Sevilla Sanchez D, Placeres Alsina MM, Miana Mena MT, Lopez Sune E, Codina Jane C, Ribas Sala J. [Pharmaceutical intervention with parenteral nutrition]. Farm Hosp. 2010;34(1):9-15. doi: 10.1016/j.farma.2009.09.001
13. Brown CM, Barner JC, Shepherd MD. Issues and barriers related to the provision of pharmaceutical care in community health centers and migrant health centers. J Am Pharm Assoc (2003). 2003;43(1):75-77. doi: 10.1331/10865800360467088
14. Martin-Calero MJ, Machuca M, Murillo MD, Cansino J, Gastelurrutia MA, Faus MJ. Structural process and implementation programs of pharmaceutical care in different countries. Curr Pharm Des. 2004;10(31):3969-3985.
15. Awad A, Al-Ebrahim S, Abahussain E. Pharmaceutical care services in hospitals of Kuwait. J Pharm Pharm Sci. 2006;9(2):149-157.
16. Katoue MG, Awad AI, Schwinghammer TL, Kombian SB. Pharmaceutical care in Kuwait: hospital pharmacists' perspectives. Int J Clin Pharm. 2014;36(6):1170-1178. doi: 10.1007/s11096-014-0013-z
17. Anoz Jimenez L, Borras Almenar C, Cavera Rodrigo E. [Pharmaceutical procedures in patients under treatment with total parenteral nutrition]. Farm Hosp. 2004;28(5):349-355.
18. Matowe L, Al-Kandery AS, Bihzad SM. Pharmacy in Kuwait. Am J Health Syst Pharm. 2003;60(15):1591-1592.
19. Kheir N, Al Saad D, Al Naimi S. Pharmaceutical care in the Arabic-speaking Middle East: literature review and country informant feedback. Avicenna. 2013;2:1-9.
20. Palamarek B, Friesen E. A survey of parenteral nutrition programs. Can J Hosp Pharm. 1988;41(5):263-266.
21. Maisonneuve N, Raguso CA, Paoloni-Giacobino A, Muhlebach S, Corriol O, Saubion JL, Hecq JD, Bailly A, Berger M, Pichard C. Parenteral nutrition practices in hospital pharmacies in Switzerland, France, and Belgium. Nutrition. 2004;20(6):528-535.
22. Seres D, Sacks GS, Pedersen CA, Canada TW, Johnson D, Kumpf V, Guenter P, Petersen C, Mirtallo J. Parenteral nutrition safe practices: results of the 2003 American Society for Parenteral and Enteral Nutrition survey. JPEN J Parenter Enteral Nutr. 2006;30(3):259-265.
23. Katoue MG, Awad AI, Schwinghammer TL, Kombian SB. Pharmaceutical care education in Kuwait: pharmacy students' perspectives. Pharm Pract (Granada). 2014;12(3):411.
24. Al-Taweel D, Awad A, Johnson BJ. Pharmacists’ contributions to the delivery of pharmaceutical care to patients with type 2 diabetes in Kuwait. Int J Diabetes Dev Ctries. 2014;34(2):108-115. doi: 10.1007/s13410-013-0169-4
25. Smith F. Health services research methods in pharmacy: Qualitative interviews. Int J Pharm Pract. 1998;6:97-108.
26. Huston P, Rowan M. Qualitative studies. Their role in medical research. Can Fam Physician. 1998;44:2453-2458.
27. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77-101.
28. Barbour RS. Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? BMJ. 2001;322(7294):1115-1117.
29. Meadows N. Monitoring and complications of parenteral nutrition. Nutrition. 1998;14(10):806-808.
30. Dodds ES, Murray JD, Trexler KM, Grant JP. Metabolic occurrences in total parenteral nutrition patients managed by a nutrition support team. Nutr Clin Pract. 2001;16(2):78-84. doi: 10.1177/088453360101600204
31. Salgado TM, Moles R, Benrimoj SI, Fernandez-Llimos F. Exploring the role of renal pharmacists in outpatient dialysis centres: a qualitative study. Int J Clin Pharm. 2012;34(4):569-578. doi: 10.1007/s11096-012-9645-z
32. Vantard N, Ranchon F, Schwiertz V, Gourc C, Gauthier N, Guedat MG, He S, Kiouris E, Alloux C, You B, Souquet PJ, Freyer G, Salles G, Trillet-Lenoir V, Rioufol C. EPICC study: evaluation of pharmaceutical intervention in cancer care. J Clin Pharm Ther. 2015;40(2):196-203. doi: 10.1111/jcpt.12242
33. Ayers P, Adams S, Boullata J, Gervasio J, Holcombe B, Kraft MD, Marshall N, Neal A, Sacks G, Seres DS, Worthington P. A.S.P.E.N. parenteral nutrition safety consensus recommendations. JPEN J Parenter Enteral Nutr. 2014;38(3):296-333. doi: 10.1177/0148607113511992
34. Faber EM. Program for training staff pharmacists in total parenteral nutrition. Am J Hosp Pharm. 1991;48(5):980-986.
35. Mitchell KA, Jones EA, Meguid MM, Curtas S. Standardized TPN order form reduces staff time and potential for error. Nutrition. 1990;6(6):457-460.
36. Matowe L, Abahussain EA, Al-Saffar N, Bihzad SM, Al-Foraih A, Al-Kandery AA. Physicians' perceptions and expectations of pharmacists' professional duties in government hospitals in Kuwait. Med Princ Pract. 2006;15(3):185-189.
37. McDermott LA, Albrecht JT, Good DH. Nutritional support: pharmacists' influence on the prescribing process. Top Hosp Pharm Manage. 1994;14(3):30-39.
38. McShane CM, Fox HM. Nutrition support teams--a 1983 survey. JPEN J Parenter Enteral Nutr. 1985;9(3):263-268.
39. Hagiwara S, Mori T, Tuchiya H, Sato S, Higa M, Watahiki M, Hoshina M, Mochizuki T, Chiba T, Miwa A, Kawachi S. Multidisciplinary nutritional support for autologous hematopoietic stem cell transplantation: a cost-benefit analysis. Nutrition. 2011;27(11-12):1112-1117. doi: 10.1016/j.nut.2010.11.010
40. Hvas CL, Farrer K, Donaldson E, Blackett B, Lloyd H, Forde C, Garside G, Paine P, Lal S. Quality and safety impact on the provision of parenteral nutrition through introduction of a nutrition support team. Eur J Clin Nutr. 2014;68(12):1294-1299. doi: 10.1038/ejcn.2014.186
41. Trujillo EB, Young LS, Chertow GM, Randall S, Clemons T, Jacobs DO, Robinson MK. Metabolic and monetary costs of avoidable parenteral nutrition use. JPEN J Parenter Enteral Nutr. 1999;23(2):109-113.
42. Kennedy JF, Nightingale JM. Cost savings of an adult hospital nutrition support team. Nutrition. 2005;21(11-12):1127-1133.
43. The World Health Organization. Framework for action on interprofessional education and collaborative practice. 2010; available at: http://www.who.int/hrh/nursing_midwifery/en/ (accessed 4 April, 2016).
44. Gallagher RM, Gallagher HC. Improving the working relationship between doctors and pharmacists: is inter-professional education the answer? Adv Health Sci Educ Theory Pract. 2012;17(2):247-257. doi: 10.1007/s10459-010-9260-5
45. Kochevar M, Guenter P, Holcombe B, Malone A, Mirtallo J. ASPEN statement on parenteral nutrition standardization. JPEN J Parenter Enteral Nutr. 2007;31(5):441-448.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 Unported License.
Maram G. Katoue
MSc. Pharmacology,
MSc. Diabetes Care and Education.
Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Kuwait University.
Teaching Assistant.
Dalal Al-Taweel
PhD. Pharmacy Practice.
Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University.
Assistant Professor.