Do Dietary Supplements Have a Place in Health Systems?
Fullas, Fekadu, Drug Topics
Do dietary supplements have a place in health systems? That has been the question when patients are admitted for acute care. There have been various published surveys conducted to answer this question. The answers, however, have varied from total prohibition of supplements being used in some hospitals to allowing them under certain conditions. So the approaches taken have varied from one hospital to another.
Allowing these supplements has required at times only a written physician order, or in some cases as much as a patient's consent. Some hospital policies are somewhat fuzzy in that they invoke what seems to be a long process of Institutional Review Board interventions for inpatient use of these products. In general, hospitals that have barred supplements have cited concern over patient risk and possible alternative medicine-conventional medication interactions. In almost all cases, dietary supplements are not part of hospital formularies. Instead, patients are requested to bring in their own supplies of supplements that they had been taking prior to admission.
The term "dietary supplements" has been used in the literature interchangeably with terms such as "alternative medicines [substances]," "complementary medicines," and "nutraceuticals." According to the Dietary Supplement Health and Education Act (DSHEA), dietary supplements are defined as products intended to supplement the diet, and include vitamins, minerals, herbs, amino acids, metabolites, etc. The Joint Commission gives some latitude to hospitals for managing "orders for herbal products" in a comprehensive way. Further, it classifies dietary supplements and herbal products under a broader category of nutraceuticals, which are used with the intention of deriving medical or health benefits.
ASHP is of the opinion that all efforts should be made to closely monitor the use of alternative substances in the inpatient setting, including but not limited to, obtaining the patient's consent with appropriate documentation should such use become necessary. It also advocates adoption of clear policies on the subject. In addition, ASHP is against the inclusion of supplements in hospital formularies, owing to lack of sufficient safety and efficacy data on a par with the evidence involved in Food & Drug Administration-approved conventional prescription and/or over-the-counter medications.
Until now, alternative medicine has not been regulated with the same level of rigorous requirements as conventional medications. …