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Nutrition in acute and chronic diseases

The experience and outcomes of multidisciplinary clinical pharmacist-led parenteral nutrition service for individuals with intestinal failure in a center without home parenteral nutrition

Abstract

Background/objectives

Intestinal Failure (IF) is a rare but serious form of organ failure, and patients with IF are dependent on Total Parenteral Nutrition (TPN) to maintain growth and development. This study aimed to describe the experiences of a multidisciplinary clinical pharmacist-led TPN service in the Intestinal Rehabilitation Unit of Shiraz Organ Transplant Center.

Subjects/methods

This prospective study was conducted in Shiraz Organ Transplant Center, Iran from February 2018 to October 2020, including seven months with and 24 months without the clinical pharmacist involvement. Clinical and nutritional outcomes as well as the potential complications of TPN were compared in these two periods.

Results

This study was conducted on 107 patients. The most important complication occurred among the patients receiving TPN were catheter infection (42.05%), sepsis, and catheter thrombosis (18.69%). Portal vein thrombosis (OR = 26.56) and length of Intensive Care Unit (ICU) stay (OR = 1.12) were significantly associated with the rate of parenteral nutrition-associated liver disease. The results also revealed an association between the rate of sepsis and history of malignancy, catheter thrombosis, length of the small bowel, length of PN, length of hospital stay, and length of ICU stay. Moreover, the results showed a significant difference regarding the patients’ outcomes and TPN complications before and after the clinical pharmacist interventions (P < 0.05).

Conclusion

Working as a multidisciplinary team in Intestinal Rehabilitation Unit (IRU) has been suggested to improve patients’ outcomes and reduce mortality and morbidity. Presence of a clinical pharmacist in this team can help improve the TPN service provided for individuals with IF.

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Acknowledgements

The authors are grateful for Ms. A. Keivanshekouh at the Research Consultation Center (RCC) of Shiraz University of Medical Sciences and Dr. Nasrin Shokrpour at the Center for Development of Clinical Research of Nemazee Hospital for improving the use of English in the manuscript.

Funding

This research did not receive any grants from funding agencies in the public, commercial, or not-for-profit sectors.

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MS, HN and MM designed the study; MS and HN conducted the research; MS and MM analyzed the data; MS, MM, and HN wrote the paper; HN reviewed the article critically for important intellectual content. All authors read and approved the final paper.

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Correspondence to Mahtabalsadat Mirjalili.

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Shafiekhani, M., Nikoupour, H. & Mirjalili, M. The experience and outcomes of multidisciplinary clinical pharmacist-led parenteral nutrition service for individuals with intestinal failure in a center without home parenteral nutrition. Eur J Clin Nutr (2022). https://doi.org/10.1038/s41430-021-01048-4

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