Critical Care Self-Assessment Program (CCSAP) Book 2: Nutrition and Fluids (Cert # L249248)

The target audience Critical Care Self-Assessment Program (CCSAP) Book 2: Nutrition and Fluids is board-certified and advanced level critical care clinical pharmacists.

Board certified pharmacists are eligible to receive up to 18 contact hours of recertification credit for completing this course. To earn recertification credit, learners must review the course content and successfully complete the online assessments by the deadline.   

ASHP provides an opportunity for remediation. Participants who are unsuccessful with the first assessment attempt may take a second assessment. The second assessment is included at no additional cost.

ACCP and ASHP are approved by BPS as a provider for the recertification of BCCCP.

Nutrition and Fluids I
ACPE #: 0217-9999-24-203-H01-P

Chapter: Nutrition Support in Critically Ill Patients

• Distinguish which critically ill patients require nutrition intervention based on the degree of malnutrition.
• Evaluate the appropriate route and timing of nutrition support initiation, based on degree of malnutrition, degree of illness, and GI function.
• Distinguish between different types of access for parenteral nutrition (PN) and enteral nutrition (EN) and considerations for long-term versus short-term therapy.
• Develop a care plan with an appropriate balance of macronutrients, based on substrate use, to avoid overfeeding and to manage refeeding syndrome.
• Apply monitoring parameters to assess both EN and PN tolerance.
• Distinguish between updates from the 2016 and 2021 guidelines and apply changes to current practice. 

Chapter: Parenteral Nutrition Controversies

• Discover discrepancies among existing nutrition support guidelines for critically ill patients.
• Evaluate timing of parenteral nutrition (PN) initiation in critically ill adult patients.
• Distinguish clinical scenarios that warrant cautious initiation of PN in critically ill adult patients.
• Design appropriate PN regimens in critically ill adult patients.
• Examine adverse effects historically associated with PN use in critically ill adult patients.
• Distinguish PN use in terminally ill ICU patients. 

Nutrition and Fluids II
ACPE #: 0217-9999-24-204-H01-P

Chapter: Nutrition Support in Surgical Patients

• Justify the importance of early nutrition intervention in critically ill surgical patients.
• Assess for nutrition support contraindications in critically ill surgical patients.
• Assess calorie and protein requirements of critically ill surgical patients.
• Evaluate the impact of nutrition support on outcomes in critically ill surgical patients.
• Develop an appropriate nutrition plan for critically ill surgical patients. 

Chapter: Nutrition Support in Patients Requiring Complex Care

• Distinguish how extracorporeal support used in ICU patients affects calorie and protein goals.
• Devise strategies for monitoring micronutrient therapy in patients receiving extracorporeal support.
• Analyze nutrition support considerations in critically ill adults with different types of liver failure and disease.
• Develop nutrition support plans for patients admitted to the ICU with severe pancreatitis.
• Evaluate strategies to optimize nutrition support in the setting of chronic critical illness. 

Nutrition and Fluids III
ACPE #: 0217-9999-24-205-H01-P

Chapter: Enteral Nutrition and Drug-Nutrient Interactions

• Evaluate appropriate indications and methods for the provision of enteral nutrition (EN).
• Develop EN regimens according to individual patient characteristics.
• Distinguish whether medications are appropriate for administration through an enteral access device (EAD).
• Apply strategies for appropriately administering medications through an EAD. 

Chapter: Micronutrient Deficiencies in Critically Ill Patients

• Apply an understanding of the scientific basis of micronutrient (MN) therapies to patients with critical illness.
• Distinguish the difference between assays used to analyze MN concentrations.
• Evaluate MN concentrations to assess deficiency states and determine indications for replacement therapy.
• Assess the merits and limitations of published clinical trials evaluating MN therapies in critical illness.
• Evaluate the appropriate route, timing, and dosing of MNs in relationship to the patient-specific factors.
• Develop a care plan based on clinical situations needing close attention to MN supplementation. 

Nutrition and Fluids IV
ACPE #: 0217-9999-24-206-H01-P

Chapter: Parenteral Nutrition Safety

• Develop a care plan for an appropriate parenteral nutrition (PN) order according to safety and compatibility standards.
• Apply standardized strategies to minimize PN prescription, transcription, and typographic errors.
• Design a plan for dosing, administration, and monitoring of lipid injectable emulsion (ILE) therapy for a critically ill adult patient to prevent essential fatty acid deficiency (EFAD) and other complications.
• Assess appropriate values and frequency of PN monitoring to ensure the safety of therapy and prevent potential complications. 

Case Series: Parenteral Nutrition Transitions of Care

• Apply the rationale for assessing a parenteral nutrition (PN) formula upon transition of care (TOC).
• Assess patient-specific characteristics that should be considered during TOC in patients receiving PN.
• Implement strategies according to best practices for safe TOC for critically ill patients receiving PN. 

Nutrition and Fluids V
ACPE #: 0217-9999-24-207-H01-P

Case Series: Probiotics and Stress Ulcer Prophylaxis

• Distinguish between different risk factors for GI bleeding to determine when stress ulcer prophylaxis (SUP) is indicated.
• Apply the existing evidence supporting use of the available agents for SUP to select an optimal regimen.
• Account for potential adverse effects associated with acid-suppressive agents when determining the appropriateness of therapy.
• Analyze the clinical impact of disruptions of the gut microbiota secondary to critical illness.
• Justify the role of probiotics in the prevention and management of clinical conditions in the ICU.
• Evaluate potential challenges to the use of probiotics in clinical practice.

Faculty Information

In accordance with our accreditor’s Standards of Integrity and Independence in Accredited Continuing Education, ASHP requires that all individuals in control of content disclose all financial relationships with ineligible companies. An individual has a relevant financial relationship if they have had a financial relationship with an ineligible company in any dollar amount in the past 24 months and the educational content that the individual controls is related to the business lines or products of the ineligible company. 

An ineligible company is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The presence or absence of relevant financial relationships will be disclosed to the activity audience. 

The following persons in control of this activity’s content have relevant financial relationships:

• Consultancies: Sara Bliss (Fresenius Kabi); Todd W. Canada (Fresenius Kabi); Sarah Cogle (Pharmacosmos Therapeutics, Inc., Fresenius Kabi USA, LLC); Alexandre Ivanov (Fresenius Kabi); Vanessa Kumpf (Fresenius Kabi, VectivBio, Baxter); Diana W. Mulherin (Baxter Healthcare, Pharmacosmos Therapeutics, Inc.); Rina Patel (Baxter); Gordon S. Sacks (American Society for Parenteral and Enteral Nutrition, Board of Pharmacy Specialties); Vivian Zhao (Board of Pharmacy Specialties)
• Stock Ownership: Christopher T. Buckley (Bristol Myers Squibb, Unitedhealth Group); Melissa Noble (Veru)
• Royalties: Grants: Sara Bliss (Baxter Nutrition); Susan Hamblin (Prytime Medical equipment; U.S. Army Medical Research Development Command [DoD]); Vivian Zhao (9 Meters Biopharma, Takeda [two grants]) Honoraria: Todd W. Canada (Fresenius Kabi)
• ACCP Staff/Series Leaders
  • Consultancies: Alexander H. Flannery (La Jolla Pharmaceutical Company); Lisa Hall Zimmerman (SCCM [two consultancies], American College of Osteopathic Surgeons [spouse or significant other])
  • Grants: Alexander H. Flannery (La Jolla Pharmaceutical Company)

All other persons in control of content do not have any relevant financial relationships with an ineligible company. 

As required by the Standards of Integrity and Independence in Accredited Continuing Education, all relevant financial relationships have been mitigated prior to the CPE activity.

Activities consist of educational materials, assessments, and activity evaluations. In order to receive continuing pharmacy education credit, learners must:

• Complete the attestation statement
• Review all content
• Complete and pass the assessments
• Complete the evaluations 

Follow the prompts to claim, view, or print the statement of credit within 60 days after completing the activity. 

ACCP and ASHP collaborate on critical care pharmacy activities.