A Call to Action for Optimizing the Electronic Health Record in the Parenteral Nutrition Workflow

Abstract

Parenteral nutrition (PN) is a complex therapeutic modality provided to neonates, children, and adults for various indications. Surveys have shown that current electronic health record (EHR) systems are in need of functionality enhancement for safe and optimal delivery of PN. This is a consensus statement from the American Society for Parenteral and Enteral Nutrition, the Academy of Nutrition and Dietetics, and the American Society of Health-System Pharmacists outlining some of the key challenges to prescribing, order review/verification, compounding, and administration of PN using EHRs today and is a call to action for clinicians and vendors to optimize their EHRs regarding the PN build and workflow.

Significant Published Articles for Pharmacy Nutrition Support Practice in 2018

“…[6][7][8][9][10][11][12][13] An additional 13 articles comprising organizational guidelines, consensus, recommendation, and position papers included separately as important papers to our practice. [14][15][16][17][18][19][20][21][22][23][24][25][26] Of these 21 finalist publications, 5 were published in Journal of Parenteral and Enteral Nutrition,4 in Clinical Nutrition, 3 in Anesthesia & Analgesia, 2 in Nutrition in Clinical Practice, and 2 in New England Journal of Medicine. The remaining 5 papers were from 5 different journals.…”

“…Abola et al 14 American Society for Enhanced Recovery and Perioperative Quality Initiative joint consensus statement on patient-reported outcomes in an enhanced recovery pathway Barazzoni et al 15 Sarcopenic obesity: Time to meet the challenge Calder et al 16 Lipids in the intensive care unit: Recommendations from the ESPEN Expert Group Erick et al 17 ACOG Practice Bulletin 189: Nausea and vomiting of pregnancy Gianotti et al 18 Nutritional support and therapy in pancreatic surgery: A position paper of the International Study Group on Pancreatic Surgery (ISGPS) Guenter et al 19 Standardized competencies for parenteral nutrition administration: The ASPEN model Hedrick et al 20 American Society for Enhanced Recovery and Perioperative Quality Initiative joint consensus statement on postoperative gastrointestinal dysfunction within an enhanced recovery pathway for elective colorectal surgery Jensen et al 21 GLIM criteria for the diagnosis of malnutrition: A consensus report from the global clinical nutrition community Lal et al 22 Clinical approach to the management of intestinal failure-associated liver disease (IFALD) in adults: A position paper from the Home Artificial Nutrition and Chronic Intestinal Failure Special Interest Group of ESPEN Pironi et al 23 Intestinal failure in adults: Recommendations from the ESPEN expert groups Ukleja et al 24 Standards for nutrition support: Adult hospitalized patients Vanek et al 25 A call to action for optimizing the electronic health record in the parenteral nutrition workflow Wischmeyer et al 26 American Society for Enhanced Recovery and Perioperative Quality Initiative joint consensus statement on nutrition screening and therapy within a surgical enhanced recovery pathway baseline (p < 0.01). Early biomarker changes may predict later changes in DB concentrations, as demonstrated by positive correlations between differences in stigmasterol (r = 0.68, p = 0.03) and IL-8 (r = 0.75, p < 0.01) concentrations.…”

Electronic Health Record and Parenteral Nutrition Functionality: A Gap Analysis

“…The gap analysis (Figure 1) included 40 processes/functions identified by the multiorganizational, call to action, PN-EHR manuscript. 6 The questions in the gap analysis were adopted from the ISMP Medication Safety Self Assessment for High-Alert Medications tool utilized by hospitals nationally, including those in the system. 7 For each process, the respondent had the option of choosing 1 of the following responses:…”

The Drug Shortage Era: A Scoping Review of the Literature 2001–2019

“…Further research may be necessary to develop informatics systems that are flexible to supply disruptions. 45 Few analyses exist on the potential effects of policies to prevent shortages. Other disciplines may be able to add insight in this area, including economists, industrial engineers, and psychologists.…”

“…There are opportunities to improve projections, increase collaborations between institutions, and develop further guidance for treatments in times of shortage. Further research may be necessary to develop informatics systems that are flexible to supply disruptions 45 …”