title: Role of the pharmacist in parenteral nutrition therapy: challenges and opportunities to implement pharmaceutical care in Kuwait.
abstract: BACKGROUND
  Pharmacists can provide beneficial pharmaceutical care services to patients receiving Parenteral Nutrition (PN) therapy by working within Nutrition Support Teams (NSTs).
  
  
  OBJECTIVE
  This study was designed to explore pharmacists' role in PN therapy in hospitals of Kuwait, sources of PN-related information, opinions on NSTs, perceptions about the barriers to pharmaceutical care implementation and views on how to enhance their practices.
  
  
  METHODS
  Data were collected via face-to-face semi-structured interviews with the senior Total Parenteral Nutrition (TPN) pharmacists at all the hospitals which provide TPN preparation services (six governmental hospitals and one private hospital) in Kuwait. Descriptive statistics were used to describe pharmacists' demographic details and practice site characteristics. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.
  
  
  RESULTS
  The pharmacists mainly performed technical tasks such as TPN compounding with minimal role in providing direct patient care. They used multiple different sources of TPN-related information to guide their practice. They reported positive and negative experiences with physicians depending on their practice environment. None of the hospitals had a functional NST. However, pharmacists expressed preference to work within NSTs due to the potential benefits of enhanced communication and knowledge exchange among practitioners and to improve service. Pharmacists perceived several barriers to providing pharmaceutical care including lack of reliable sources of TPN-related information, lack of a standard operating procedure for TPN across hospitals, insufficient staff, time constraints and poor communication between TPN pharmacists. To overcome these barriers, they recommended fostering pharmacists' education on TPN, establishing national standards for TPN practices, provision of pharmacy staff, development of NSTs, enhancing TPN pharmacists' communication and conducting TPN-research research.
  
  
  CONCLUSIONS
  TPN pharmacists in Kuwait are confined to performing TPN manufacturing processes. There are promising avenues for future development of their role in patient care. This can be achieved by overcoming the barriers to pharmaceutical care practice and providing pharmacists with educational opportunities to equip them with the clinical competencies needed to practise as nutrition support pharmacists with patient-centred roles.
authors.affiliation: Teaching Assistant, Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Kuwait University . Kuwait ( Kuwait ). maramk@hsc.edu.kw.
authors.forename: Maram G
authors.identifier: 0000-0001-9604-8911
authors.initials: MG
authors.lastname: Katoue
authors.affiliation: Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University . Kuwait ( Kuwait ). d.altaweel@hsc.edu.kw.
authors.forename: Dalal
authors.identifier: 0000-0002-0091-3323
authors.initials: D
authors.lastname: Al-Taweel
keywords: Kuwait; Parenteral Nutrition; Pharmacists; Professional Practice; Professional Role; Qualitative Research