ASHP/ASPEN Nutrition Support Certificate

This program is intended for pharmacists, physicians, and other healthcare professionals interested in learning about nutrition support therapy.

Learning Activity	ACPE Number	Contact Hours
Malnutrition Assessment, Prevention, and Treatment	0204-0000-22-750-H01-P	2.25
Nutritional Requirements	0204-0000-22-751-H01-P	2.25
Nutrition Support Access	0204-0000-22-752-H01-P	1.50
Enteral and Parenteral Nutrition Products	0204-0000-22-753-H01-P	1.75
Nutrition Support Ordering	0204-0000-22-754-H01-P	1.50
Enteral and Parental Product Preparation and Distribution	0204-0000-22-755-H01-P	1.75
Nutrition Administration	0204-0000-22-756-H01-P	1.25
Nutrition Support Complications, Part 1	0204-0000-22-757-H01-P	1.00
Nutrition Support Complications, Part 2	0204-0000-22-758-H01-P	3.00
Nutrition Support Complications, Part 3	0204-0000-22-759-H01-P	1.50
Ongoing Monitoring of Nutrition Support	0204-0000-22-760-H01-P	1.25
Error Reporting System	0204-0000-22-761-H05-P	1.00
→  Final Assessment: (80% passing score required)

Prevention, Assessment, and Treatment of Malnutrition
0204-0000-22-750-H01-P

• Describe an etiology-based approach to diagnosing malnutrition.
• Identify patients at risk for malnutrition.
• Recognize clinical outcomes that are affected negatively by malnutrition.
• Employ an appropriate referral process to nutritional specialists.
• Formulate a step-wise nutrition assessment process for patients with nutritional problems.
• Use appropriate criteria to diagnose the presence of malnutrition.
• Review strategies for communicating and documenting nutritional care in the electronic health record.
• Describe ways to address a patient’s nutritional needs in response to changes in clinical status across the healthcare continuum.
• Differentiate between disease and nutritional issues in specific disease states.
• Select appropriate nutrition interventions to mitigate disease specific consequences on clinical outcomes.

The American Society of Health-System Pharmacists designates this enduring material for a maximum of 2.25 AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nutritional Requirements
0204-0000-22-751-H01-P

• Evaluate parenteral nutrition orders for the appropriate content and use of macronutrients based on estimated requirements.
• Design a parenteral nutrition formulation that limits dextrose provision while balancing overall nutrient requirements.
• Compare minimum requirements of available lipid emulsion formulations to prevent essential fatty acid deficiency.
• Calculate a patient’s estimated fluid requirements using the three most common methods.
• Evaluate the clinical need to modify fluid provision compared to calculated maintenance fluid requirements.
• Assess the electrolyte content of an initial parenteral nutrition formulation.
• Recommend appropriate electrolyte content adjustments in a parenteral nutrition order, based on a given patient scenario.
• Discuss the importance of providing the full dose of intravenous multivitamin daily in parenteral nutrition.
• Evaluate the trace element content of a parenteral nutrition formulation.
• Discuss the assessment timeline and potential consequences for continuing “empiric” additions or deletions of components to a parenteral nutrition formulation.

The American Society of Health-System Pharmacists designates this enduring material for a maximum of 2.25 AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nutrition Support Access
0204-0000-22-752-H01-P

• Identify factors that influence the selection of an appropriate vascular access device for parenteral nutrition.
• Compare and contrast the vascular access options available for administering parenteral nutrition.
• Describe strategies for preventing potential complications of vascular access devices
• Identify factors that influence the selection of the appropriate enteral access device.
• Compare and contrast the access options available for enteral nutrition.
• Describe strategies for preventing potential complications of enteral access devices.

The American Society of Health-System Pharmacists designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Enteral and Parenteral Nutrition Products
0204-0000-22-753-H01-P

• Differentiate broad categories of enteral formulas: polymeric, defined diet (elemental), disease specific.
• Identify appropriate enteral formulas for the critically ill population.
• Analyze enteral formula labels for key characteristics.
• Differentiate among available parenteral nutrition products.
• Compare advantages and disadvantages of standardized commercially-available parenteral nutrition products versus customized parenteral nutrition formulations.
• Select parenteral nutrition products based on relevant patient characteristics, availability, stability and compatibility. 

The American Society of Health-System Pharmacists designates this enduring material for a maximum of 1.75 AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nutrition Support Ordering
0204-0000-22-754-H01-P

• Discuss the key elements and functionality of the electronic health record for enteral and parenteral nutrition orders.
• Review the appropriate ordering process for multi-chamber parenteral nutrition products.
• Design a transition of care regimen for patients receiving enteral or parenteral nutrition.

The American Society of Health-System Pharmacists designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Enteral and Parental Product Preparation and Distribution
0204-0000-22-755-H01-P

• Compare the differences between preparing a closed- vs. open-system enteral nutrition product.
• Review safe practices for labeling enteral or parenteral nutrition products.
• Identify safe transition practices in patient care from hospital to home for enteral or parenteral nutrition products.
• Recommend strategies for handling parenteral nutrition product shortages.
• Asess the parenteral nutrition compatibility issues for a given formulation.
• Differentiate between stability concerns for 2-in-1 nutrition versus total nutrient admixture formulations.
• Describe educational instruction techniques for home preparation of parenteral nutrition.

The American Society of Health-System Pharmacists designates this enduring material for a maximum of 1.75 AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nutrition Support Administration
0204-0000-22-756-H01-P

• Review critical safety measures for initiating parenteral or enteral nutrition.
• Identify measures aimed at preventing tubing misconnections involving enteral and parenteral nutrition systems.
• Discuss administration procedures for parenteral nutrition to prevent complications related to tubing and inline filter changes.
• Outline safe medication administration practices with concurrent enteral or parenteral nutrition
• Distinguish steps in managing total nutrient admixture vs. 2-in-1 parenteral nutrition with separate lipid injectable emulsion infusions.

The American Society of Health-System Pharmacists designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nutrition Support Complications, Part 1
0204-0000-22-757-H01-P

• Identify nutrition support patients at risk for refeeding syndrome.
• Propose adjustments in enteral and parenteral nutrition delivery to minimize refeeding syndrome occurrence.
• Review the clinical algorithm for controlling hyperglycemia in patients receiving nutrition support.
• Design a treatment plan for patients with hyperglycemia.

The American Society of Health-System Pharmacists designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nutrition Support Complications, Part 2
0204-0000-22-758-H01-P

• Identify nutrition support patients at risk of micronutrient deficiency.
• Develop a treatment plan for managing micronutrient deficiency.
• Recognize essential fatty acid deficiency in parenteral nutrition patients.
• Analyze patient information to determine the type of fluid and sodium disorder.
• Describe common etiologies of fluid and sodium disorders and their impact on the nutrition prescription.
• Design recommendations for the prevention and management of fluid and sodium disorders.
• Analyze patient information to determine the type of electrolyte disorder.
• Describe common etiologies of electrolyte disorders and their impact on the nutrition prescription.
• Design recommendations for the prevention and management of electrolyte disorders.
• Analyze patient information to determine the type of acid-base disorder.
• Describe common etiologies of acid-base disorders and their impact on the nutrition prescription.
• Design recommendations for the prevention and management of acid-base disorders.

The American Society of Health-System Pharmacists designates this enduring material for a maximum of 3.0 AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nutrition Support Complications, Part 3
0204-0000-22-759-H01-P

• Identify gastrointestinal complications in patients receiving enteral nutrition.
• Recommend strategies for managing gastrointestinal complication in enterally fed patients.
• Assess risk of pulmonary aspiration in patients receiving enteral nutrition.
• Discuss the impact of nutrition support on hepatic, renal and pulmonary function.

The American Society of Health-System Pharmacists designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Ongoing Monitoring of Nutrition Support
0204-0000-22-760-H01-P

• Examine clinical conditions that affect tolerance of nutrition support.
• Identify disease states that may increase the risk for complications related to nutrition support.
• Design an appropriate monitoring plan for patients fed enterally and parenterally to minimize and prevent complications.
• Determine appropriate nutrition support interventions based on results of laboratory testing.
• Establish appropriate therapeutic goals for patients on nutrition support.
• Propose adjustments to a nutrition support prescription based on progress toward therapeutic goals.

The American Society of Health-System Pharmacists designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Error Reporting System
0204-0000-22-761-H05-P

• Describe errors and potential errors that may occur with parenteral and enteral nutrition
• Examine error reporting methods to evaluate error trends that may occur with parenteral and enteral nutrition.
• Explain the importance of reporting errors associated with nutrition support.
• Select appropriate systems and processes for potential safety improvements.

The American Society of Health-System Pharmacists designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Phil Ayers, Pharm.D., BSNCP, FASHP
Chief, Clinical Pharmacy Services
Mississippi Baptist Medical Center
Clinical Associate Professor, Pharmacy Practice
University of Mississippi
Jackson, Mississippi

Todd W. Canada, Pharm.D., BCNSP, BCCCP, FASHP, FTSHP, FASPEN
Clinical Pharmacy Services Manager
Nutrition Support Team Coordinator
University of Texas MD Anderson Cancer Center
Houston, Texas

Andrew Mays, Pharm.D., BCNSP, CNSC
Clinical Pharmacy Specialist
University of Mississippi Medical Center
Clinical Assistant Professor
University of Mississippi School of Pharmacy
University, Mississippi

Jay M. Mirtallo, M.S., R.Ph, BCNSP, FASHP, FASPEN
The Professor Emeritus
The Ohio State University, College of Pharmacy
Clinical Practice Specialist
American Society for Parenteral and Enteral
Nutrition
Delaware, Ohio

Kris M. Mogensen, M.S., R.D.-A.P., LDN, CNSC
Team Leader Dietitian Specialist
Brigham and Women’s Hospital
Boston, Massachusetts

David C. Evans, M.D., FACS, FASPEN
Trauma, Critical Care, General & Gastrointestinal Surgery
OhioHealth Grant Medical Center & Mansfield Hospital
Adjunct Clinical Professor of Surgery
Ohio University
Medical Director
OhioHealth Transfer Center
Medical Director
OhioHealth Nutrition Support Team
Columbus, Ohio

Ainsley Malone, M.S., RDN, L.D., CNSC, FAND, FASPEN
Clinical Practice Specialist
The American Society for Parenteral and Enteral
Nutrition (ASPEN)
Nutrition Support Dietitian
Mount Carmel Grove City
Columbus, Ohio

Anne M. Tucker, Pharm.D., BCNSP
Clinical Pharmacy Specialist
University of Texas MD Anderson Cancer Center
Houston, Texas

Patricia Worthington, R.N., M.S.N.,CNSC
Retired
Previously: Nutrition Support Clinical Nurse Specialist
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania

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 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:

• Phil Ayers: Fresenius Kabi, speaker and consultant
• David C. Evans: Abbott Laboratories, speaker and consultant; Alcresta, speaker and consultant, CVS/OptionCare, consultant; Fresenius Kabi, speaker and consultant
• Andrew Mays:  Fresenius Kabi, speaker
• Jay M. Mirtallo: Fresenius Kabi, speaker and consultant
• Kris M. Mogensen: Baxter, speaker; Thrive Rx,  advisory board member; Pfizer, advisory board member

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 definition of ineligible company, all relevant financial relationships have been mitigated prior to the CPE activity.

This internet enduring material activity consists of a combined total of 12 learning modules. Pharmacists, and nurses are eligible to receive a total of 20 hours of continuing education credit by completing all 12 modules within this certificate program.

Physicians are eligible to be awarded up to 20 AMA PRA Category 1 Credits^TM by completing all 12 modules within this certificate program.

Continuing education credits must be claimed within 60 days of being earned.

All participants must complete each module and evaluation, as well as score 70% or higher on the assessment test to earn continuing education credit, and a score of 80% or higher in the final exam to earn the certificate.  Follow the prompts online at the ASHP eLearning portal (http://elearning.ashp.org) to claim or be awarded credit within 60 days of completing the activity.

Pharmacists only: Your credits will be reported directly to CPE Monitor.  To verify that you have completed the required steps and to ensure your credits hours have been reported to CPE Monitor, we encourage you to check your NABP eProfile account to validate your credits were transferred successfully before the ACPE 60-day deadline.   After the 60 day deadline, ASHP will no longer be able to award credit.