Home Parenteral Nutrition and Intravenous Fluid Errors Discovered Through Novel Clinical Practice of Reconciling Compounding Records: A Case Series

Murphy, M. Kathleen; Gura, Kathleen M.; Tascione, Christina; Carey, Alexandra; Duggan, Christopher; Raphael, Bram P.

doi:10.1177/0884533617722759

Cited by 5 publications

(6 citation statements)

References 18 publications

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“…[17,34,48] Those diseases need multiple services such as nutrition support, parental or entral, anti-diabetes treatment, anticoagulant medication, cardiovascular therapy, pain management, palliative therapy, physical therapy, respiratory therapy-related medications, antibiotics, and vaccinations. [14,38,49] There are also other common chronic systems, such as constipation or diarrhea. Therefore, the home care pharmacist should implement various drug therapy strategies and provide all highly recommended medications for those conditions.…”

Section: Discussionmentioning

confidence: 99%

“…If the responders were working at the hospital and provided enteral or parental nutrition or antibiotics, that would be an appropriate answer. 49 Furthermore, suppose home care services are available for cancer patients. In that case, pain management will be a reasonable answer because the hospital pharmacy can prepare the nutrition support and might dispense the control and potent narcotic medications for cancer patients.…”

Section: Discussionmentioning

confidence: 99%

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The Home Care Clinical Pharmacy Practice in Saudi Arabia

Alomi¹,

Aghamdi²,

Jasser³

et al. 2023

Int. J. Pharmacol. Clin. Sci

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Objectives: To demonstrate the clinical pharmacy in home health care services in Saudi Arabia. Methods: It analyzes a cross-sectional survey discussing home care clinical pharmacy practice in Saudi Arabia. The survey consisted of respondents' demographic information about the workforce's pharmacists, Pharmacotherapy classes utilization for home healthcare patients, and therapeutic guidelines implemented in Home Healthcare Pharmacy services. The 5-point Likert response scale system was used with closed-ended questions. The survey was validated through the revision of expert reviewers and pilot testing. Besides, various tests of reliability, McDonald's ω, Cronbach alpha, Gutmann's λ2, and Gutmann's λ6 were done with the study. Furthermore, the data analysis of the home care clinical pharmacy practice is done through the survey monkey system. Besides, the statistical package of social sciences (SPSS), Jeffery's Amazing Statistics Program (JASP), and Microsoft Excel sheet version 16. Results: A total number of 393 pharmacists responded to the questionnaire. Of them, more than three-quarters responded from the Central region (303 (77.10%)), with statistically significant differences between the provinces (p=0.000). Males responded less than females (195 (49.74%)) versus 197 (50.26%%)), with statistically non-significant differences between them (p=0.920). Most of the responders were in the age group of 24-35 years (267 (67.94%)) and 36-45 years (121 (30.79%)), with statistically significant differences between all age groups (p=0.000). Most responders stated that pharmacy home healthcare workforces were five or more clinical pharmacists (35.14-41.89%) and full-time pharmacy staff providing home health pharmacy services. Besides, five or more pharmacists (30.89-52.57%) and five or more pharmacy technicians (31.25-51.09%) with statistically significant differences between all workforce numbers (p=0.000). Most medications reviewed or dispensed for home healthcare patients include Nutrition support (4.50) and Vitamins and mineral supplements (4.49). They were followed by NSAIDs or Pain killers (4.46) and Antibiotics (4.45), with statistically significant differences between all answers (p=0.000). The average score of therapeutic guidelines implemented in Home healthcare Pharmacy services was (4.29). The element "The standard considerations of urology disease therapy guidelines" obtained the highest score (4.44). The element "The standard considerations of acute and chronic kidney disease therapy among geriatric patients" was (4.41), and the aspect "The concerns and management of Gastrointestinal therapeutic guidelines" was (4.38). Conclusion: Nutrition support and vitamin were most used as pharmacotherapy classes for home healthcare services. The urology and nephrology therapeutic guidelines were most implemented. Future research is needed to determine most home care clinical pharmacy services and identify the role of clinical practitioners in home health care services in Saudi Arabia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Home Care Clinical Pharmacy Practice in Saudi Arabia

Alomi¹,

Aghamdi²,

Jasser³

et al. 2023

Int. J. Pharmacol. Clin. Sci

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“…With each transition of care, the PN records should be reviewed for discrepancies. 42 Within the first 24 h after their initial discharge home, many teams use a telemedicine visit to assess the patient and confirm how the patient/caregiver(s) will store their PN and manage their supplies. Some teams may send a hospital-based nurse to the home, whereas others will expect the home health provider or home health agency nurse to meet the family at home and assist in setting up the first night's PN preparation and infusion.…”

Section: Follow-upmentioning

confidence: 99%

“…Reports from each provider should be readily accessible to other healthcare professionals to avoid duplication of laboratory tests or inappropriate changes to the PN order. With each transition of care, the PN records should be reviewed for discrepancies 42 …”

Section: Communicate the Nutrition Care Planmentioning

confidence: 99%

Safe care transitions for patients receiving parenteral nutrition

Adams,

Gura,

Seres

et al. 2022

Nut in Clin Prac

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Transitions of care require coordination between inpatient healthcare providers, care managers, outpatient/ambulatory providers, and the patient/caregiver and family members. Poor communication during transitions of care can affect health outcomes and economic costs for patients/caregivers, healthcare providers, and healthcare systems. The goal of this paper is to identify risk‐prone processes in the transition of care for patients requiring parenteral nutrition (PN) between healthcare environments, including the hospital, home, skilled nursing facility, and long‐term acute care hospital settings. To facilitate the evaluation of the transition, a sequential series of steps in the transition process were identified: initial notification, assessment in preparation for transfer, identifying the receiving organization, identifying accountable providers at each sending/receiving organization, communicating the nutrition care plan, implementing the plan and additional considerations regarding PN preparation and readmissions. Safety concerns with risk‐prone processes are identified and recommended best practices are proposed for improving processes at each step of the transition. Pediatric considerations are included in the evaluation of the various steps in the transition of care. This paper was approved by the American Society for Parenteral and Enteral Nutrition (ASPEN) Board of Directors.

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“…The reconciliation of HPN orders was the focus of a pediatric interdisciplinary HPN program that evaluated compounding accuracy in their patients receiving HPN therapy . HPN compounding records (showing exact content of compounding components) were compared with the prescribed order for accuracy by HPN pharmacists on the team.…”

Section: Home Infusion Challengesmentioning

confidence: 99%

Challenges and Obstacles of Long‐Term Home Parenteral Nutrition

Kumpf

2019

Nut in Clin Prac

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Patients receiving long‐term home parenteral nutrition (HPN) and clinicians managing their care face complex challenges not fully addressed by existing clinical practice guidelines. This review aims to increase awareness of some of the challenges encountered when managing patients receiving HPN and provide strategies for management. The ability to optimally manage these patients starts with involvement of a qualified team of clinicians, which is sometimes difficult to find. There are unique challenges related to the parenteral nutrition (PN) prescribing and compounding process that are not typically encountered with inpatient use. Clear communication is required between the HPN prescriber/team and the home infusion pharmacist to prevent errors related to misinterpretation of the order and PN product shortages. Dependency on HPN and living with chronic disease create a number of psychosocial, financial, and other lifestyle restrictions that can negatively impact a patient's quality of life. HPN nonadherence is a challenge that complicates the clinician's ability to accurately assess and make appropriate adjustments to therapy. HPN adherence may be improved by incorporating a patient‐centered approach to care that allows patients to prioritize those issues most meaningful and valuable to them. Patient‐centered care also encourages self‐care and relies on a high level of HPN education. Clinicians are encouraged to use an interactive interview style when engaging patients to prioritize goals of care and make self‐motivated decisions for change. In spite of challenges, HPN therapy has allowed patients the ability to maintain adequate nutrition and thrive in the home setting when the oral/enteral route fails.

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Home Parenteral Nutrition and Intravenous Fluid Errors Discovered Through Novel Clinical Practice of Reconciling Compounding Records: A Case Series

Cited by 5 publications

References 18 publications

The Home Care Clinical Pharmacy Practice in Saudi Arabia

The Home Care Clinical Pharmacy Practice in Saudi Arabia

Safe care transitions for patients receiving parenteral nutrition

Challenges and Obstacles of Long‐Term Home Parenteral Nutrition

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