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Hospital Healthcare Europe

The British Pharmaceutical Nutrition Group

Michael Allwood
1 January, 2008  

Michael Allwood
BPharm PhD
FRPharmSGB
Secretary
British Pharmaceutical Nutritional Group

As a specialist interest organisation, the British Pharmaceutical Nutrition Group (BPNG) has built upon their beginnings as a problem-solving committee in parenteral nutrition (PN) mixtures and today exist to provide a variety of services to its members and others ­directly ­involved in the ­formulation and delivery of clinical nutrition. In particular, the group makes ­strenuous efforts to provide the following:

  • Education and training in all aspects of clinical nutrition of interest to pharmacy. This includes basic and advanced training and sharing of experience and knowledge on all pharmaceutical aspects of clinical nutrition, including not only pharmaceutical nutrition (PN) but also issues associated with enteral nutrition (EN), which involve the ­pharmacist.
  • A resource of pharmaceutical expertise, which can be offered, for example, via the group’s website.
  • An informed and expert response to official government and professional policy statements and ­documents involving any aspect of clinical nutrition of interest to pharmacy. 
  • Encourage links between pharmacists and those pharmaceutical and technical companies with ­interests in any aspects of PN and pharmacy-managed aseptic operations.
  • Encourage research through the identification of pharmaceutical problems and issues in clinical ­nutrition, sometimes providing limited funding, and opportunities to share the results of such research with colleagues.
  • Expert advice on relevant issues by publishing best-practice research-based guidelines and position papers on key aspects of safe PN.

The BPNG is therefore highly active in supporting the profession, providing the focus for ­pharmacists, technicians and other professionals with an interest in all pharmaceutical aspects of clinical nutrition. The group celebrated its 18th anniversary in 2006. It has provided a focus for all those interested in the ­pharmaceutical and clinical aspects of prescribing and administering artificial nutrition. While BPNG’s primary attention has always been associated with PN, it has also shown an increasing ­interest in the problems associated with medicines administration to patients receiving nourishment via ­gastric or jejunal access.

During the past 15 years or so, the group has provided regular meetings in the UK with a major focus on education and training as well as developing the knowledge and skills of practitioners, particularly in the design and compounding of safe PN mixtures to meet the needs of all types of patients. For example, in 2001 the group published new guidelines on the use of inline filters in PN ­administration, and more recently has prepared updated guidance on the safe addition of phosphate to PN for publication.(1)

The BPNG also works closely with colleagues in the pharmaceutical industry, many of whom are ­corporate members, sharing common problems and collaborating in areas of mutual interest and benefit. They hold regular meetings to share views on such issues as current training needs and their provision in shared training meetings, support and contributions at its annual symposium, the provision of clinical and technical information to colleagues, and assistance from industry in the various projects undertaken by BPNG.

So today this active specialist group is involved in many projects and contributions to the safe and most effective delivery of PN, whether in hospital or homecare settings. In the area of enteral feeding, the group has developed and published a comprehensive guide for the administration of medicines to ­patients through tube feeding. This important new contribution to safe clinical practice is designed to provide information and guidance to anyone responsible for administering medicines to patients with an enteral tube. It covers the types of tubes used and methods for flushing such tubes, as well as how to maintain or restore patency. Guidance on clinical issues associated with administering drugs via nasogastric tubes, such as altered bioavailability, how to prepare medication for administration (for example, the crushing of ­tablets and the dilution of liquid medicines), appreciation of various types of drug-feed interactions, both ­physical and therapeutic, and health and safety issues is provided.

One of the group’s most popular meetings is the annual training day for pharmacists new to ­involvement in PN. This basic introduction to PN includes sessions on indications for PN, line access and monitoring, producing prescriptions and formulae, practical stability issues and a session on the ethical issues – “To feed or not to feed?” Learning is reinforced by case discussions presented by ­experts (pharmacists and clinicians).
 
Current projects:
“Clogbusters”  One of the most serious problems associated with long-term PN is line occlusion. Both causes and remedies remain elusive, and BPNG is developing a series of projects to investigate this and shed further light on both cause and solution. The first project in the “Clogbusters” investigation is to ascertain current experiences in UK hospitals regarding both the occurence of line occlusion and the different strategies that hospitals have adopted in attempting to remove blockages. We are exploring such questions as the possible link between the composition of the PN mixture and the frequency of occlusion, the length of treatment between blockages, and the success or otherwise of methods to remove occlusions from blocked lines.

The second project aims to obtain information on the different types and sources of catheters employed in the administration of PN and again examines possible links between the type and nature of the line and the frequency of occlusion.

The third and most technically demanding project is to seek samples of blocked lines from hospitals in order to examine the nature and composition of the material causing the occlusion. Finally, we are planning to develop a laboratory model which aims to replicate the problem in the laboratory and then examine the effectiveness of different methods of removing the blockage, based on knowledge of actual and potential methods used in clinical practice.

NICE guidelines  The National Institute for Health and Clinical Excellence (NICE) has recently published guidance on best practice in the use of PN in practice, and BPNG has made a significant contribution to these recommendations.

Web advise service  The group maintains a website, and members are encouraged to post any problems and queries they experience for comment and advice from other members. This is proving to be an ­invaluable service to members, and a wide range of problems and queries have received responses from colleagues who have had similar experiences and can provide solutions. As an illustration of its value, recent examples include responses to a query concerning the consequences of adding acetate salts to PN mixtures, and the use of antibiotic and ethanol locks to treat and prevent line infections. This is a major contribution to best practice in PN, and it also encourages more involvement by pharmacists in the delivery and management of PN services. 

“Feeding Times”  This is the periodic newsletter of the group, informing members of new developments and current issues in clinical nutrition.

Inline filters development and application  The group has a long interest in the use of inline filters, and has previously published guidelines on their choice and application. This is currently being reviewed, and updated recommendations are expected shortly.

The executive committee is constantly reviewing the needs of its membership and so other current projects include the development of a supplementary prescribing pack for pharmacists, and a position paper which hopes to provide a valued comparison for the user of standard vs individualised PN feeds. In conclusion, BPNG is highly active in supporting the profession. It provides the focus for ­pharmacists, technicians and other professions with an interest in clinical nutrition, emphasising the safe and effective prescribing, preparation and delivery of PN, both in the secondary sector and for home patients.

Reference

  1. BPNG Guidelines Nutrition, 2001;17(5):403-8

Resources
White, R, Bradnam V. Handbook of drug administration via enteral feeding tubes. Pharmaceutical Press, London; 2006
British Pharmaceutical Nutrition Group
W: www.bpng.co.uk