November 20, 2002
September 4, 2015
Clinical Nutrition Services
Guidelines for Patient Instruction Drug-
To establish guidelines for the provision of individualized instruction and counseling on
potential drug nutrient interactions and dietary precautions and modifications prior to
discharge for patients, family, and/or caregivers.
Certain medications are recognized to have clinically significant or potentially clinically
significant drug nutrient interactions as determined jointly by the Nutrition Committee and the
Pharmacy and Therapeutic Committee. The role of the pharmacist, clinical nutritionist, and
nurse are defined. Clinical staff works in an interdisciplinary manner to identify, manage and
provide patient education about potential drug-nutrient interactions and to schedule
medication administration in relation to meals and other feedings.
III. FORMS USED
Health Link Electronic Medical Record (EMR): Medication Administration Record (MAR) and
Patient Teaching Activity
Nutrition Care for You…Patient Education Materials
Health Facts for You…Patient Education Materials
A. Written materials to be used for patient education will be available for medications that
require (when appropriate) management of drug-nutrient interactions.
B. Patient medication information is available in the electronic medical record [Health Link
medication administration record (MAR)].
C. Counseling/instruction for patients receiving identified medications may include review of
the anticipated drug-nutrient interaction and the appropriate dietary modification. Patient
learning assessment (barriers, preferences, readiness, and priorities) is reviewed. After the
counseling session, education and materials along with an assessment of the patient's
understanding shall be documented in the patient teaching activity.
D. The pharmacist will review medication orders for clinically significant or potentially clinically
significant drug-nutrient interactions and adjust medication administration instructions and
medication schedules as appropriate.
E. Real and potential drug nutrient interactions in patients on tube feeding or parenteral
nutrition will be identified and managed. Recommendations for adjusting the tube feeding
and/or parenteral nutrition formula will be made in the electronic medical record.
Medications administered through a feeding tube shall be given in liquid form when
possible and/or crushed and mixed with water. Medications shall not be directly mixed
with the tube feeding formula, in order to minimize the risk of potential drug nutrient
interactions within the tube feeding formula. Enteral feeding tube shall be flushed with at
least 30 mLs of water before and after medication administration.
F. The clinical nutritionist, Learning Center or pharmacist will review the anticipated drug-
nutrient interactions with the patient, family member, and/or caregiver and will provide
counseling and written instructions on the appropriate prophylactic dietary modification as
indicated prior to discharge or in the ambulatory setting. Drug-Nutrient categories
identified for dietary modification with consultation by the clinical nutritionist when
requested by nursing, pharmacy, the primary team, or the patient/family are: insulin and
oral diabetes agents (newly diagnosed diabetes), anticonvulsants, monoamine oxidase
inhibitors, drugs with MAOI activity, corticosteroids (long term use), anti-inflammatory
(sulfasalazine) immunosuppressant (tacrolimus, sirolimus, and cyclosporine) and
G. The nurse and other healthcare providers assess education needs, provide appropriate
instruction, and document the patient, family member, and/or caregiver specific knowledge
on potential food-drug interactions and/or skill needed to meet the patient's relevant
healthcare needs, taking into account the teaching, learning which has occurred prior to the
patients admission or clinic/home care visit.
H. The care team member providing the education documents the education in the electronic
Drug-Nutrient Interaction Counseling Guidelines - Clinical Nutrition
UWHC - Clinical Nutrition Guide for Adult Patients
Sr. Management Sponsor: Chief Nurse Executive and Senior Vice President Patient Care
Services and Senior Vice President Professional and Support Services
Author: Clinical Nutrition Services
Review: Pharmacy, Nursing, Clinical Nutrition
Approval: Nutrition Committee and Pharmacy and Therapeutics Committee
Director, Culinary and Clinical Nutrition Services
Associate Chief Nursing Officer and VP Development, Nursing & Patient Care Services