Hospital Pharmacist
2006;13:361-364
November 2006

Peri-operative nutrition — the role of the pharmacist

By Rebecca White, MRPharmS

This article, the second in a special feature on nutrition in hospital, describes the nutritional issues that pharmacists need to consider in surgical patients. Potential interactions between nutrients in enteral feeds and drugs are also discussed

This article as FULL TEXT PDF (60K)

See also Peri-operative medication series

SUMMARY

The pharmacist has always been an essential member of the multidisciplinary nutrition support team, traditionally involved in providing technical advice on parenteral nutrition. However, pharmacist involvement in nutrition has also demonstrated a positive effect on clinical outcomes such as fluid balance and the transition from parenteral to enteral or oral feeding.

There are many opportunities for hospital pharmacist involvement in aspects of nutritional care in the surgical patient — it is not just the remit of the nutrition team pharmacist. Every pharmacist can have a positive impact on patients’ nutritional status and assist in diet and therapy modification to minimise any decline in nutritional status during hospital stay.

Malnutrition is a common problem in peri-operative patients, since the underlying disease may cause reduced nutrient intake (due to dysphagia, intestinal obstruction or anorexia) or malabsorption (due to chronic inflammation, biliary obstruction, pancreatic disease or intestinal fistulae). Nutrient requirements may be increased and intake is often decreased. Surgical management and drug therapy can also cause a decrease in nutrient intake, further compounding this problem.

Nutrition plays a key role in peri-operative care. Appropriate intervention in the pre-operative phase can positively affect post-operative outcome with a reduction in complications and length of stay.

The link between poor nutritional status and post-operative complications was first identified in the 1930s,4 and yet malnourished patients are still being admitted for elective surgery without appropriate intervention.