Impact of clinical pharmacist-based parenteral nutrition service for bone marrow transplantation patients: a randomized clinical trial.
OBJECTIVE
Parenteral nutrition (PN) is a well-documented supportive care which maintains the nutritional status of patients. Clinical pharmacists are often involved in providing PN services; however, few studies have investigated the effect of a clinical pharmacy-based PN service in resource-limited settings.


METHODS
We designed a randomized clinical trial to compare the clinical pharmacist-based PN service (intervention group) with the conventional method (control group) for adult patients undergoing hematopoietic stem cell transplantation in Shariati Hospital, Tehran, Iran (2011-2012). In the intervention group, the clinical pharmacists implemented standard guidelines of nutrition support. The conventional method was a routine nutrition support protocol which was pursued for all patients in the bone marrow transplantation wards. Main study outcomes included nutritional status (weight, albumin, total protein, pre-albumin, and nitrogen balance), length of hospital stay, time to engraftment, rate of graft versus host disease, and mortality rate. Patients were followed for 3 months.


RESULTS
Fifty-nine patients were randomly allocated to a study group. The overall intake (oral and parenteral) in the control group was significantly lower than standard daily needed calories (P < 0.01). Patients in the intervention group received fewer days of PN (10.7 ± 4.2 vs. 18.4 ± 5.5 days, P < 0.01). All nutritional outcomes were either preserved or improved in the intervention group while the nutritional status in the control group was deteriorated (P values < 0.01). Length of hospital stay was significantly shorter in the intervention group (P < 0.01). Regarding PN complications, hyperglycemia was observed more frequently in the intervention group (34.5 %, P = 0.01). Two patients in the control group expired due to graft versus host disease at the 3-month follow-up.


CONCLUSIONS
A clinical pharmacist-based nutrition support service significantly improved nutritional status and clinical outcomes in comparison with the suboptimal conventional method. Future studies should assess the cost effectiveness of clinical pharmacists' PN services.
Department of Clinical Pharmacy, Faculty of Pharmacy, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran, Mousavinm@mums.ac.ir.
Maryam
M
Mousavi
Alireza
A
Hayatshahi
Amir
A
Sarayani
Molouk
M
Hadjibabaie
Mohammadreza
M
Javadi
Hassan
H
Torkamandi
Kheirollah
K
Gholami
Ardeshir
A
Ghavamzadeh
D000328:Adult; D002149:Energy Intake; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007492:Iran; D008297:Male; D044342:Malnutrition / Q000178:diet therapy* / Q000517:prevention & control*; D009752:Nutritional Status; D010288:Parenteral Nutrition / Q000379:methods*; D010595:Pharmacists; D010607:Pharmacy Service, Hospital / Q000379:methods*; D016037:Single-Blind Method; D019172:Transplantation Conditioning / Q000379:methods