If nutritional support is all you do, you have a pretty large service with lots of patients.
If you are in a teaching institution, you are often on "rounds" first. If there is a nutritional support "team" which follows all pts on enteral & tpn, then you round with that team. Otherwise...you generally will round with the group with the most pts at the time - it can change from surgery, to medicine, to oncology, depending on who is the most unstable at the time. You can't be in all places at once, however. So....if you are in a teaching insitution, you often make sure the pharmacist who normally rounds with that team is aware of your issues.
If you are not in a teachiing institution, there often are not formal rounds. So, you must see each pt & read the chart as to what has occurred the last 24 hours.
Other than teaching hositals, there are also physician based ordering & pharmacist based ordering. If it is physician based, you make sure you've seen the AM labs, seen what has gone on with the pt the last 24 hours, seen what is planned for that pt the next 24 hours & make sure the physician has ordered the changes for the tpn, if any. Most places require all tpn changes to be written by 11AM. We make sure it happens much earlier than that. If the changes don't make sense with what has occurred lab-wise or clinically or with the plan ahead...we contact the physician to talk about it.
If it is pharmacist based ordering, you do the same - you evaluate the pt over the last 24 hours, look at the am labs, see what the plan is & write the order changes.
If the pt changes level of acuity or services - to or from an intensive care for example, the whole tpn gets rewritten to its current formula so there is no confusion.
After getting order changes, you bring them all to the pharmacy and make the appropriate change in the comounding forumula for the techs. You process the orders, have the techs mix, check the mix & the labeling, then you start all over again the next day.
In between, you have to communicate with dietary on appropriate weaning efforts to enteral formulas from tpn. You hear from them also on patients who are not doing well with enteral & follow those patients even before they get put on tpn....you try not to put somone on it if you can help it. You try peripheral measures first & definitely the gut always.
There are always meetings thrown in, other issues with these pts - fluid problems, antibiotic dosing issue, pain issues.....you work with lots of different people because these are such complex patients.
Monthly, you have to meet to discuss patients and any unusual situation which have come up. Annually, you have to review all your forms and standards & make sure they come up to what is current.
There is probably more, but I can't think of it right now.
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