This product is an ASHP Learning Center activity.

Acreditation

The American Society of Health-System Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education with Commendation.

Target Audience

This activity is intended for pharmacists seeking to expand their knowledge and skills in nutritional support management.

Overview

The Nutrition Support Certificate was produced in collaboration with the American Society for Parenteral and Enteral Nutrition (ASPEN). This self-guided certificate is comprised of online home study activities that will be accredited for pharmacists.

The certificate activities incorporate recorded presentations, readings, and exercises designed to assess the learners’ ability to understand, analyze, and apply materials relevant to nutrition support practice. The curriculum covers malnutrition, nutritional requirements for adult patients receiving nutrition support, a review of best practices for ordering, access, preparation and administration of nutrition support, an overview of potential complications that could result from enteral or parenteral nutrition, as well as ongoing monitoring and error reporting. After completing the certificate, participants should be proficient in fundamental concepts related to nutrition support care for adult patients.

ASHP/ASPEN Nutrition Support Professional Certificate Requirement

Once a learner has completed the educational curriculum, they will have the opportunity to complete an online comprehensive final exam. Once the learner completes the exam (minimum 80% passing rate; unlimited attempts permitted), they will earn the professional certificate.

Educational Activities

Malnutrition Assessment, Prevention, And Treatment
ACPE: 0204-0000-24-828-H01-P
Application-based
2.5 contact hours

Learning Objectives:

• Describe an etiology-based approach to diagnosing malnutrition.
• Identify patients at risk for malnutrition.
• Use an appropriate referral process to nutritional specialists.
• Describe clinical outcomes that are affected negatively by malnutrition.
• Plan a step-wise nutrition assessment process for patients with nutritional problems.
• Use appropriate criteria to diagnose the presence of malnutrition.
• Differentiate between disease and nutritional issues in specific disease states.
• Select appropriate nutrition interventions to mitigate disease specific consequences on clinical outcomes.
• Summarize strategies for communicating and documenting nutritional care in the electronic health record.
• Describe ways to address a patient’s nutritional needs in response to changes in clinical status across the healthcare continuum.

Nutritional Requirements
ACPE: 0204-0000-24-829-H01-P
Application-based
2 contact hours

Learning Objectives:

• Evaluate parenteral nutrition orders for the appropriate content and use of macronutrients based on estimated requirements.
• Design a parenteral nutrition formulation that limits dextrose provision while balancing overall nutrient requirements.
• Compare minimum requirements of available lipid emulsion formulations to prevent essential fatty acid deficiency.
• Calculate a patient’s estimated fluid requirements using the three most common methods.
• Evaluate the clinical need to modify fluid provision compared to calculated maintenance fluid requirements.
• Assess the electrolyte content of an initial parenteral nutrition formulation.
• Discuss the importance of providing the full dose of intravenous multivitamin daily in parenteral nutrition.
• Evaluate the trace element content of a parenteral nutrition formulation.
• Discuss the assessment timeline and potential consequences for continuing “empiric” additions or deletions of components to a parenteral nutrition formulation.

Nutrition Support Access
ACPE: 0204-0000-24-830-H01-P
Application-based
1.5 contact hours

Learning Objectives:

• Identify factors that influence the selection of the appropriate enteral access device.
• Compare the access options available for enteral nutrition.
• Describe strategies for preventing potential complications of enteral access devices.
• Identify factors that influence the selection of the appropriate vascular access device for PN.
• Compare the vascular access options available for administering parenteral nutrition.
• Describe strategies for preventing potential complications of vascular access devices.

Enteral And Parenteral Nutrition Products
ACPE: 0204-0000-24-831-H01-P
Application-based
1.5 contact hours

Learning Objectives:

• Differentiate among available parenteral nutrition products.
• Compare advantages and disadvantages of standardized multi-chamber bag parenteral nutrition versus customized parenteral nutrition formulations.
• Select parenteral nutrition products based on relevant patient characteristics, availability, stability and compatibility.
• Differentiate broad categories of enteral formulas: polymeric, defined diet (elemental), disease specific.
• Identify appropriate enteral formulas for the critically ill population.
• Analyze enteral formula labels for key characteristics.

Nutrition Support Ordering
ACPE: 0204-0000-24-832-H01-P
Application-based
1.5 contact hours

Learning Objectives:

• Discuss the key elements and functionality of the electronic health record (EHR) for enteral and parenteral nutrition orders.
• Summarize the appropriate ordering process for multi-chamber parenteral nutrition products.
• Design a transition of care regimen for patients receiving enteral or parenteral nutrition.

Enteral and Parental Product Preparation and Distribution
ACPE: 0204-0000-24-833-H01-P
Application-based
1.5 contact hours

Learning Objectives:

• Compare the differences between preparing closed- vs. open-system enteral nutrition products.
• Describe safe practices for labeling enteral and parenteral nutrition products.
• Identify safe transition practices in patient care from hospital to home for enteral and parenteral nutrition products.
• Recommend strategies for handling parenteral nutrition product shortages.
• Assess the parenteral nutrition compatibility issues for a given formulation.
• Differentiate between stability concerns for 2-in-1 parenteral nutrition versus total nutrient admixture formulations.
• Describe educational instruction techniques for home preparation of parenteral nutrition.

Nutrition Administration
ACPE: 0204-0000-24-834-H01-P
Application-based
1 contact hour

Learning Objectives:

• Identify critical safety measures for initiating parenteral or enteral nutrition.
• Identify measures aimed at preventing tubing misconnections involving enteral and parenteral nutrition systems.
• Discuss administration procedures for parenteral nutrition to prevent complications related to tubing and inline filter changes.
• Distinguish steps in managing TNA vs. 2-in-1 parenteral nutrition with separate lipid injectable emulsion infusions.
• Summarize safe medication administration practices with concurrent enteral or parenteral nutrition.
• Distinguish steps in managing total nutrient admixture vs. 2-in-1 parenteral nutrition with separate lipid injectable emulsion infusions.

Nutrition Support Complications, Part 1
ACPE: 0204-0000-24-835-H01-P
Application-based
1 contact hour

Learning Objectives:

• Identify nutrition support patients at risk for refeeding syndrome.
• Propose adjustments in enteral and parenteral nutrition delivery to minimize refeeding syndrome occurrence.
• Describe the clinical algorithm for controlling hyperglycemia in patients receiving nutrition support.
• Design a treatment plan for patients with hyperglycemia.

Nutrition Support Complications, Part 2
ACPE: 0204-0000-24-836-H01-P
Application-based
3 contact hours

Learning Objectives:

• Identify nutrition support patients at risk for micronutrient deficiency.
• Develop a treatment plan for managing micronutrient deficiency.
• Describe essential fatty acid deficiency in parenteral nutrition patients.
• Analyze patient information to determine the type of fluid & sodium disorder.
• Describe common etiologies of fluid & sodium disorders and their impact on the nutrition prescription.
• Design recommendations for the prevention and management of fluid and sodium disorders.
• Analyze patient information to determine the type of electrolyte disorder.
• Describe common etiologies of electrolyte disorders and their impact on the nutrition prescription.
• Design recommendations for the prevention and management of electrolyte disorders.
• Analyze patient information to determine type acid-base disorder.
• Describe common etiologies of acid-base disorders and their impact on the nutrition prescription.
• Design recommendations for the prevention and management of acid-base disorders.

Nutrition Support Complications, Part 3
ACPE: 0204-0000-24-837-H01-P
Application-based
1.25 contact hours

Learning Objectives:

• Identify gastrointestinal complications in patients receiving enteral nutrition.
• Recommend strategies for managing gastrointestinal complications in enterally fed patients.
• Assess risk of pulmonary aspiration in patients receiving enteral nutrition.
• Discuss the impact of nutrition support on hepatic, renal, and pulmonary function.

Ongoing Monitoring of Nutrition Support
ACPE: 0204-0000-24-838-H01-P
Application-based
1.25 contact hours

Learning Objectives:

• Evaluate clinical conditions that affect tolerance of nutrition support.
• Identify disease states that may increase the risk for complications related to nutrition support.
• Design an appropriate monitoring plan for patients fed enterally and parenterally to minimize and prevent complications.
• Determine appropriate nutrition support interventions based on results of laboratory testing.
• Assess appropriate therapeutic goals for patients on nutrition support.
• Recommend adjustments to a nutrition support prescription based on progress toward therapeutic goals.

Error Reporting System
ACPE: 0204-0000-24-839-H01-P
Application-based
1 contact hour

Learning Objectives:

• Describe errors and potential errors that may occur with parenteral and enteral nutrition.
• Analyze error reporting methods to evaluate error trends that may occur with parenteral and enteral nutrition.
• Describe the importance of reporting errors associated with nutrition support.
• Select appropriate systems and processes for potential safety improvements.

Faculty Information

Phil Ayers, PharmD, BSNCP, FASHP
Chief, Clinical Pharmacy Services
Mississippi Baptist Medical Center
Clinical Associate Professor, Pharmacy Practice
University of Mississippi
Jackson, Mississippi

Todd Canada, PharmD, BCNSP, BCCCP, FASHP, FTSHP, FASPEN
Clinical Pharmacy Services Manager
Nutrition Support Team Leader
University of Texas MD Anderson Cancer Center
Houston, Texas

David Evans, MD, FACS, FASPEN
Trauma and Acute Care Surgeon
OhioHealth Trauma and Surgical Services
Columbus, Ohio

Ainsley Malone, MS, RDN, LD, CNSC, FAND, FASPEN
Clinical Practice Specialist
The American Society for Parenteral and Enteral Nutrition (ASPEN)
Nutrition Support Dietitian
Mount Carmel Grove City
Columbus, Ohio

Andrew Mays, PharmD, BSNCP, CNCS
Clinical Pharmacy Specialist
University of Mississippi Medical Center
Clinical Assistant Professor
University of Mississippi
Jackson, Mississippi

Jay Mirtallo, MS, RPh, BCNSP, FASHP, FASPEN
The Professor Emeritus
The Ohio State University, College of Pharmacy
Clinical Practice Specialist
American Society for Parenteral and Enteral Nutrition
Delaware, Ohio

Kris Mogensen, MS, RD-AP, LDN, CNSC
Team Leader Dietitian Specialist
Brigham and Women's Hospital
Boston, Massachusetts

Gordon Sacks, PharmD, BCNSP, FASPEN, FCCP
Nutrition Support & Pharmacotherapy Consultant (independent)
Clinical Professor
Auburn University College of Pharmacy
Auburn, Alabama

Anne Tucker, PharmD, BCNSP, FASPEN
Clinical pharmacy Specialist
University of Texas MD Anderson Cancer Center
Houston, Texas

Patricia Worthington, RN, MSN, CNSC
Retired: Nutrition Support Clinical Nurse Specialist
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania

Relevant Financial Relationship Disclosure

In accordance with our accreditor’s Standards of Integrity and Independence in Accredited Continuing Education, ASHP requires that all individuals in control of content disclose all financial relationships with ineligible companies. An individual has a relevant financial relationship if they have had a financial relationship with ineligible company in any dollar amount in the past 24 months and the educational content that the individual controls is related to the business lines or products of the ineligible company. An ineligible company is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The presence or absence of relevant financial relationships will be disclosed to the activity audience.

The following persons in control of this activity’s content have relevant financial relationships:

• Phil Ayers, PharmD, BCNSP, FASHP
• Fresenius Kabi: Speaker's bureau

• Todd W. Canada, PharmD, BCCCP, BCNSP, FASHP, FASPEN, FTSHP
• Fresenius Kabi: Speaker's bureau

• David C. Evans, MD, FACS, FCCM, FASPEN
• Abbott Nutrition: Consultant, speaker's bureau
• Alcresta Therapeutics: Consultant, speaker's bureau
• Fresenius Kabi: Consultant, speaker's bureau

• Jay M. Mirtallo, MS, RPh, BCNSP, FASHP, FASPEN
• Fresenius Kabi: Consultant
• Wolters Kluwer: Consultant

All other persons in control of content do not have any relevant financial relationships with an ineligible company.

As defined by the Standards of Integrity and Independence definition of ineligible company. All relevant financial relationships have been mitigated prior to the CE activity.

Methods and CE Requirements

Each activity consists of audio, video, and/or PDFs and evaluations. Learners must review all content and complete the evaluations to receive continuing pharmacy education credit for each activity.

Follow the prompts to claim, view, or print the statement of credit within 60 days after completing the activity.

Important Note – ACPE 60 Day Deadline:
Per ACPE requirements, CPE credit must be claimed within 60 days of being earned. To verify that you have completed the required steps and to ensure your credits have been reported to CPE Monitor, check your NABP eProfile account to validate that your credits were transferred successfully before the ACPE 60-day deadline. After the 60-day deadline, ASHP will no longer be able to award credit for this activity.

The ASHP Professional Certificates ^SM educational product line contains learning activities that are ACPE-accredited knowledge and application-based continuing education. This is not an ACPE Certificate Program. Upon successful completion of the activities, the learner will be able to download an ASHP Professional Certificate.

System Technical Requirements

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