The Task Force reviewed existing published literature in electronic databases and secondary source literature on order writing practices for parenteral nutrition.
Because clinical guidelines cannot be based solely on prospective randomized trials, the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Task Force for Revision of Safe Practices for Parenteral Nutrition conducted the 2003 Survey of Parenteral Nutrition (PN) Practices, focusing on policies and procedures relating to ordering, compounding, and administering PN and quality oversight of this process (see "Availability of Companion Documents" field). The final document published as "Safe Practices for Parenteral Nutrition" was based primarily on the recommendations of experts in the field and was evidence-based for as much as the literature provided evidence to support these recommendations. The results from this survey were used as a basis for the revised "Safe Practices for Parenteral Nutrition" to enhance the quality and efficacy of nutrition support.
Development of the Survey Instrument
One of the survey objectives was to identify common practices related to ordering and compounding, administration of PN, and quality oversight of this process. A questionnaire based upon the existing A.S.P.E.N. "Safe Practices for Parenteral Nutrition" was developed to obtain an overview of the variance and consistency with current practices from a variety of healthcare settings. It was designed to include both hospital- and non-hospital-based PN practices. The survey instrument was not tested or validated before its distribution, but it was reviewed by a multidisciplinary panel of nutrition support practitioners and revised before becoming available for participant responses. The survey was administered electronically through the A.S.P.E.N. website and announced to the membership via society journals and A.S.P.E.N. list servers. Announcements inviting participation were also sent to selected professional groups, including the American College of Clinical Pharmacy, the American Society of Health-System Pharmacists, the National Home Infusion Association, and others. Participation in the survey was completely voluntary. The survey instrument consisted of 45 questions with multiple-choice and free-text responses. It was organized into 5 sections: demographics of the respondent, writing PN orders, computer order entry of PN orders, problems with PN orders, and adverse events related to PN. Questions in the demographic section focused on information such as professional background (i.e., MD, RN, RD, RPh, other) and primary practice setting (i.e., hospital, homecare, etc). The order writing section was designed to identify the discipline responsible for writing PN orders, whether or not standard PN order forms were used, and the manner in which PN components were ordered (i.e., dextrose in percent final concentration vs g/day, electrolytes in mEq/L vs per day, etc). The computer order entry section was designed to quantitate the use of computerized order entry systems and automated compounding devices. The final 2 sections, problems and adverse events related to PN, were developed to capture the type and frequency of harm associated with the compounding and administration of PN formulations.
Data Collection
The survey was announced on the A.S.P.E.N. website, in the society journals (e.g., Journal of Parenteral and Enteral Nutrition, Nutrition in Clinical Practice), and list servers (e.g., ASPENet) between June 1 and 30, 2003. Messages were subsequently posted to inform potential respondents of the deadline for final submission of survey responses. Participants were assured that their responses would be confidential and that only aggregate responses would be reported.
