• Mirtallo J, Canada T, Johnson D, Kumpf V, Petersen C, Sacks G, Seres D, Guenter P, Task Force for the Revision of Safe Practices for Parenteral Nutrition. Ordering parenteral nutrition. In: Safe practices for parenteral nutrition. [published erratum appears in JPEN J Parenter Enteral Nutr. 2006 Mar-Apr;30(2):17]. JPEN J Parenter Enteral Nutr 2004 Nov-Dec;28(6):S43-8. [22 references]

This is the current release of the guideline.

1. Standardized order forms (or order entry screens) shall be developed and designed for adult and pediatric parental nutrition (PN) formulations to aid prescribers in meeting the estimated daily patient nutritional requirements and improve order clarity.
2. The clinician and compounding pharmacist shall assess the PN formulation to determine whether its contents are within an acceptable standard range based on the specific patient population (e.g., adult or pediatric). They shall also assess whether a clinical disease state or condition warrants a dose outside the standard range.
3. The use of percent concentration in PN orders should not be used. The use of total daily dose is encouraged.
4. Potentially dangerous abbreviations and dose expressions should be avoided. Specifically:
   • Do not use trailing zeros (e.g., 5 mg, and not 5.0 mg)
   • Use leading zeros for doses less than one measurement unit (e.g., 0.3 mg and not .3 mg)
   • Spell out the word UNITS (e.g., never U which could be easily mistaken as a zero)
   • Spell out routes of administration and all intended instructions.

5. All components of the PN order must be re-written when PN is reordered.

Components of PN Order Forms

Mandatory for the PN Order Form

• Clarity of the form
  • Clearly written and understandable to anyone who might utilize it
  • Organized and easy to scan for completeness
  • Complete enough to address anticipated institution specific concerns
  • Ingredients listed in same order as PN label
  • Decimals and percent concentrations avoided
  • All components ordered in grams/milligrams/milliequivalents/millimoles per day or per kg per day
• Contact number for person writing the order
• Contact number for assistance with PN ordering
• Time by which orders need to be received for processing
• Location of venous access device (central or peripheral)
• Height, weight/dosing weight, diagnosis, PN indication
• Hangtime guidelines
• Institutional policy for infusion rates
• Information regarding potential incompatibilities

Strongly Recommended for Inclusion on PN Order Form

• Educational tools (e.g., dosing guidelines)
• Guidelines to assist in nutrient/volume calculations
• Recommended PN lab tests (baseline, monitoring, and special circumstances)
• Guidelines for stopping/interrupting PN
• Contents of multivitamin and trace element preparations
• Brand names of products (e.g., amino acids, intravenous fat emulsions [IVFE])
• Guidelines for use of insulin
• Guidelines for recognizing additional calorie sources

Worthy of Consideration for Inclusion on PN Order Form

• Identification of who will review the order, in addition to pharmacy
• Guidelines for nutrient restriction in various disease states
• Guidelines for long-term PN (e.g., Selenium, Iron administration)
• Guidelines for special amino acids (e.g., Trophamine + cysteine)

A sample adult PN order form is shown in Figure 1 in the original guideline document.

None provided

The recommendations are supported by a review of the literature as well as a review of parenteral nutrition order forms submitted by responders to the 2003 American Society for Parenteral and Enteral Nutrition Survey.

• Mirtallo J, Canada T, Johnson D, Kumpf V, Petersen C, Sacks G, Seres D, Guenter P, Task Force for the Revision of Safe Practices for Parenteral Nutrition. Ordering parenteral nutrition. In: Safe practices for parenteral nutrition. [published erratum appears in JPEN J Parenter Enteral Nutr. 2006 Mar-Apr;30(2):17]. JPEN J Parenter Enteral Nutr 2004 Nov-Dec;28(6):S43-8. [22 references]

Not applicable: The guideline was not adapted from another source.

2004 Dec

American Society for Parenteral and Enteral Nutrition - Professional Association

American Society for Parenteral and Enteral Nutrition

Task Force for the Revision of Safe Practices for Parenteral Nutrition

Task Force Members: Jay Mirtallo, MS, RPh, BCNSP, Chair; Todd Canada, PharmD, BCNSP; Deborah Johnson, MS, RN; Vanessa Kumpf, PharmD, BCNSP; Craig Petersen, RD, CNSD; Gordon Sacks, PharmD, BCNSP; David Seres, MD, CNSP; Peggi Guenter, PhD, RN, CNSN

Not stated

This is the current release of the guideline.

This NGC summary was completed by ECRI Institute on July 8, 2008. The information was verified by the guideline developer on July 30, 2008.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. Reprint request/permissions should be sent to: Permissions Department, ASPEN; 8630 Fenton St. #412; Silver Spring, MD 20910; Fax: 301-587-2365.