Transcript Nutrition Shortages in a Large Academic Hospital - WiSPEN

Nutrition Shortages in a Large
Academic Hospital
Caitlin Curtis, PharmD, BCNSP
Objectives
• Identify appropriate patient populations for
premixed parenteral nutrition
• Describe alternates for intravenous fluids
• Identify ways to spare intravenous
phosphate
• List options for intravenous trace elements
during shortages
Question # 1
• Is there a role for premixed parenteral
nutrition?
Question # 2
• How has your institution dealt with the
intravenous fluid shortage?
Question # 3
• How does an institution go about
decreasing intravenous phosphate usage?
Question # 4
• Is the European trace element product
compatible with the United States
parenteral nutrition components?
Question # 5
• How does one choose an oral “trace
element” to use for the formulary?
References
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Kweder S, and Dill S. Drug shortages: The cycle of quantity and quality.
Clinical Pharmacology and Therapeutics. 2013:245-251.
Busch R, Curtis C, and Kudsk K. Use of piggyback electrolytes for
patients receiving individually prescribed vs premixed parenteral nutrition.
JPEN J Parenter Enteral Nutr. 2014. published online.
DOI.10.1177/0148607113518583.
http://www.ashp.org/DocLibrary/Policy/Conservation-Strategies-for-IVFluids.pdf
http://www.nutritioncare.org/Guidelines_and_Clinical_Practice/Clinical_Pr
actice_Library/Parenteral_Nutrition_Trace_Element_Product_Shortage_
Considerations
A.S.P.E.N. Clinical Practice Committee and Nutrition Product Shortage
Subcommittee. Intravenous Trace Element Shortage Survey Report,
June 2014.
References
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http://www.fda.gov/downloads/Drugs/DrugSafety/DrugShortages/UCM3553
92.pdf (Fresenius Kabi “Dear Healthcare Professional” letter comparing
trace element profiles between European and USA products
http://www.nutritioncare.org/Guidelines_and_Clinical_Practice/Clinical_Pract
ice_Library/Parenteral_Nutrition_Electrolyte_and_Mineral_Product_Shortag
e_Considerations
Clark C, Sacks G, and Dickerson R. Treatment of hypophosphatemia in
patients receiving specialized nutrition support using a graduated dosing
scheme: results from a prospective clinical trial. Crit Care Med. 1995;
23:1504-11.