Pharmacists Perform Vital Nutrition Interventions in Hospitalized Patients

Pharmacist-based nutrition support teams play a crucial role in correcting vitamin deficiencies in hospitalized patients, according to research published in the Journal of Parenteral and Enteral Nutrition.

Researchers from Long Island University in Brooklyn, New York, retrospectively studied 132 adults aged 69 years, on average, who received nutrition support service (NSS) interventions from pharmacists at The Brooklyn Hospital Center in 2011.

Among those patients, the investigators identified 383 interventions performed by pharmacists, with an acceptance rate of 84%. Those interventions were most commonly categorized as laboratory result monitoring (92, or 24%), vitamin and trace element monitoring (86, or 22%), fluid and electrolyte management (73, or 19%), and adding medication (54, or 14%). Abnormalities were detected in about half of the laboratory results obtained, and pharmacist recommendations for vitamin and trace element monitoring were accepted 69% of the time.

Among the 38 pharmacist interventions that were not accepted, adjusting dose, diagnostics, and discontinuing medication were the most common categories. When the researchers reviewed the patients’ records to uncover why those recommendations were not accepted, the reasons ranged from providing oral rather than intravenous therapy, not checking glucose fingersticks because the patient was not diabetic, or the clinical resident forgot to make a change. Of those rejected interventions, about one-quarter (26%) led to an adverse outcome.

The authors noted that the denied interventions identified in their study could be areas to develop more pharmacist education.

“Electrolytes are checked and corrected frequently in hospitalized patients, but deficiencies in vitamins and trace elements often go unrecognized…Recognizing signs and symptoms of deficiencies along with laboratory parameters is an area where a specialized nutrition support pharmacist may play a big role,” the authors concluded. “While we did not see clinical manifestations in the majority of our patients who had deficiencies, the pharmacy NSS reviewed laboratory findings, the overall patient condition, as well as their surgical history that could have placed these patients at risk for deficiencies and would warrant further evaluation.”