Support Line


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Volume 33 Number 6 December 2011
TABLE OF CONTENTS
2Guest Editor's Perspective
Kathy M Logan Coughlin, MS, RD, LD, CNSD
Our nutrition support team had the recent misfortune of having one of our own members become ill, undergo surgery, and require parenteral nutrition (PN). Unfortunately, he even required home PN. Awkward as the situation could have been, we were happy to care for our colleague and elated to see him transition to oral feedings.
2Chair's Column
Cindy Hamilton, MS, RD, LD, CNSD
Dietitians in Nutrition Support (DNS) representation at this year's American Dietetic Association (ADA) Food & Nutrition Conference & Expo (FNCE) in San Diego, CA, was really superb! Many of you came by our booth during the DPG/MIG Showcase event just to say hello, voice your support of DNS initiatives and services, and offer suggestions for future venues.
3Complications of Home Parenteral Nutrition in Adults
Mandy L Corrigan, MPH, RD, LD, CNSC
Complications associated with parenteral nutrition (PN) can be both short- and longterm. Metabolic complications can develop with the initiation of PN in the hospital, but hypo- and hyperglycemia are potential problems associated with long-term home PN (HPN) administration. Alterations in hydration status can develop in those receiving HPN, as can deficiencies in vitamins, minerals, and trace elements. Metabolic bone disease is a significant longterm complication of PN, and the incidence of PN-associated liver disease appears to increase with the duration of HPN. Finally, nutrition support registered dietitians (RDs) must monitor patients for infectious and noninfectious catheter complications.
13Compounding Compatibility, Stability, and Safety in Parenteral Nutrition
Ning-Tsu Kuo, PharmD, PhD
Since the early 1960s, parenteral nutrition (PN) has been used as a primary source of nutrition for patients who are unable to use their gastrointestinal tracts. Over the years, clinical experience and research have improved patient care during nutrition support that includes an interdisciplinary approach to address and closely monitor each patient's individual nutrition needs. The uniqueness of PN solutions for each patient not only increases the complexity of solution compounding but necessitates that all clinicians, including physicians, dietitians, pharmacists, pharmacy technicians, and nurses, work closely together. The role of pharmacists is especially important in overseeing issues of composition, compatibility, stability, sterility, and safety during PN preparation. Additional issues involve proper storage conditions and intravenous (IV) delivery. This article highlights the chemical properties important for chemical compatibility and stability of PN admixtures and the regulations set by the United State Pharmacopeia (USP) Chapter 797 for personnel and facilities where PN admixtures are compounded. Safety issues related to ordering and compounding PN prescriptions also are addressed and examples of fatal mistakes in units of weight or volume are provided.
21Developing and Implementing Competencies for Nutrition Support Dietitians
Lindsay Dowhan, MS, RD, Robert DeChicco, MS, RD, LD, CNSC
Competencies can be used to assess whether employees possess the necessary skills and abilities to perform their duties and as a basis for designing educational, performance evaluation, and compensation programs. The roles of different disciplines in medicine often overlap, and standards of practice are constantly evolving based on new evidence and advances in technology. Organization-specific competencies can be developed by reviewing standards of practice from professional organizations, role delineation studies, and competencies from other organizations and by conducting surveys, reviewing existing job descriptions, observing employees during the performance of their duties, and interviewing managers and employees. Competencies should be integrated into an overall strategy to attract, develop, evaluate, and compensate employees and establish clear and measurable expectations for job performance. Developing and implementing competencies for nutrition support dietitians (NSDs) can increase the knowledge, skills, and abilities of individual registered dietitians (RDs); expand scope of practice; and maintain the relevancy of RDs as part of the health care team.

Copyright 2011 Dietitians in Nutrition Support, ADA.

All material appearing in SUPPORT LINE is covered by copyright and may be photocopied or otherwise reproduced for noncommercial scientific or educational purposes only, provided the source is acknowledged. Written consent from the managing editor is required for any other purpose.

Viewpoints and statements in these materials do not necessarily reflect the policies and/or official positions of The American Dietetic Association or DNS.

SUPPORT LINE (ISSN 1067-3768) is published bi-monthly. $60 for individual non-member subscriptions, $120 for institutions per year (plus postage surcharges for international subscriptions). Newsletter subscriptions are available to interested parties who are ineligible for ADA membership. Published by Dietitians in Nutrition Support, a dietetic practice group of The American Dietetic Association (ADA), 120 S. Riverside Plaza, Suite 2000, Chicago, IL 60606. For address changes: Please submit name and address changes directly to the Membership Team of the American Dietetic Association using the address change card in the Journal of the American Dietetic Association. SUPPORT LINE is indexed in the Cumulative Index to Nursing and Allied Health Literature.


FOR THIS ISSUE:

Editor

Susan Roberts, MS, RD, LD, CNSD
3911 Kramar Court
Arlington, TX 76016
214/820-6751

Managing Editor

Deborah K. Kuhlman
921 N. Western Avenue
Park Ridge, IL 60068
847/692-3407

Associate Editors

Dema Esper, MS, RD, LD

Kathy Logan Coughlin,, MS, RD, CNSD

Associate Editor, Continuing Education:

Neha Parekh, MS, RD, CNSD

Associate Editor, Writer's Mentoring:

Rebecca Brody, PhD, RD, LD, CNSC

Contributing Editor, Inquire Here:

Gail Cresci, PhD, RD, CNSD

Membership/Subscriptions:

Cheryl Thompson, PhD, RD, CNSD