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Parenteral Nutrition Safe Practices: Results of the 2003 American Society for Parenteral and Enteral Nutrition Survey*

David Seres, MD, CNSP^*, Gordon S. Sacks, PharmD, BCNSP, Craig A. Pedersen, RPh, PhD, FAPhA, Todd W. Canada, PharmD, BCNSP, Deborah Johnson, MS, RN^||, Vanessa Kumpf, PharmD, BCNSP^¶, Peggi Guenter, PhD, RN, CNSN^#, Craig Petersen, RD, CNSD^** and Jay Mirtallo, MS, RPh, BCNSP

From the ^* Beth Israel Medical Center and Albert Einstein College of Medicine, New York, New York; School of Pharmacy, University of Wisconsin, Madison, Wisconsin; College of Pharmacy, Ohio State University, Columbus, Ohio; The University of Texas MD Anderson Cancer Center, Houston, Texas;^|| Meriter Hospital, Madison, Wisconsin;^¶ Nutrishare, Inc, Elk Grove, California;^# A.S.P.E.N., Silver Spring, Maryland;^** University of California Davis Medical Center, Sacramento, California; and the The Ohio State University Medical Center, Columbus, Ohio

Correspondence: Gordon S. Sacks, PharmD, BCNSP, 777 Highland Avenue, University of Wisconsin–Madison, Madison, WI 53705. Electronic mail may be sent to gssacks{at}pharmacy.wisc.edu.

Background: The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recently published a revision of its "Safe Practices for Parenteral Nutrition" guidelines. Because there is a paucity of published scientific evidence to support good practices related to ordering, compounding, and administering parenteral nutrition (PN), a survey was performed in the process of the revision to gain insight into the discrepancies between reported practices and previous guidelines. Methods: A web-based survey consisting of 45 questions was conducted (n = 651) June 1–30, 2003. Respondents were queried about primary practice setting, professional background, processes for writing PN orders, computer order entry of PN orders, problems with PN orders, and adverse events related to PN. Results: There were 651 survey responses, 90% of which were from hospital-based practitioners. Almost 75% of responders processed between 0 and 20 PN orders per day. Overall, physicians (78%) were responsible for writing PN orders, but dietitians and pharmacists had significant involvement. PN base components were most often ordered as percentage final concentration after admixture (eg, 20% dextrose), which is inconsistent with safe practice guidelines of ordering by total amount per day (eg, 200 g/day). There was no consistent method for ordering PN electrolytes. Approximately 45% of responders reported adverse events directly related to PN that required intervention. Of these events, 25% caused temporary or permanent harm, and 4.8% resulted in a near-death event or death. Conclusions: Although the survey found consistency in PN practices for many areas queried, significant variation exists in the manner by which PN is ordered and labeled.

Journal of Parenteral and Enteral Nutrition, Vol. 30, No. 3, 259-265 (2006)
DOI: 10.1177/0148607106030003259


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