Practice ordering guidance for neonatal parenteral nutrition

Abstract

Objective: Neonatal parenteral nutrition (PN) is designed for very low birth weight infants (BWp1500 g) for whom enteral feedings are inadequate. Evaluating the clinical practice guidance (CPG) content of printed paper order forms could provide a baseline for comparison and serve as a reference for electronic neonatal nutrition order design systems.Methods: A scoring system for clinical practice guidance was developed and applied to nine institutions printed paper PN order forms. CPG scores were assigned as: (1) generic reminder only, (2) prompt with order entry space, (3) patient specific reminder only, (4) patient specific recommendation with order entry space. User-friendliness and form completion time were also recorded.Results: The overall CPG score for the six most common PN components was 1.85±0.68 (mean±1s.d.), consistent with a generic reminder, but short of a specific nutrient dose order field. Amino acid received the highest CPG score, 2.05±0.64; vitamins rated the lowest. The institution of origin was an independent predictor of the CPG score.Conclusions: Paper neonatal PN order forms offer relatively little CPG. Significant form variation and format reflects the need to standardize neonatal PN design as the neonatal PN design moves from paper to electronic ordering systems.

ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Organisational aspects

“…Reference to established guidelines for ordering and managing PN encourages appropriate selection of patients and tailoring prescriptions to the particular needs of individuals [24]. Clinical practice guidance as an aide memoire can be included on PN ordering forms [43]. The whole process of PN requires audit and critical scrutiny since life threatening errors may occur during prescribing, transcription (conversion of prescription to volumes of additives in pharmacy), dispensing, delivery to wards, and during the administration process (incorrect infusion rates) [44].…”

Prácticas de prescripción de nutrición parenteral neonatal en Portugal

“…Esta práctica es similar a la de algunos otros países 5 . En comparación con el 9% de unidades británicas e irlandesas, puede considerarse como excelente la adhesión de los neonatólogos portugueses a esta forma de prescripción, lo que permite ahorrar tiempo y reducir el margen de error 11 . En la mayoría de las unidades portuguesas existe la preocupación de la administración cautelosa de líquidos en la primera semana posnatal en recién nacidos < 1.000 g por los riesgos de sobrecarga hídrica 5,12 .…”

Parenteral Nutrition Objectives for Very Low Birth Weight Infants: Results of a National Survey

“…We identified possible reasons for the mismatch between nutritional protocol and daily practices, some of which can be easily corrected, such as those related to the precision and verification of the prescription. In that regard, a form of electronic assistance in the prescription and computerization of prescriptions has been proposed to reduce the risk of error and to optimize the parenteral nutrition of VLBW preterm infants (29)(30)(31)(32).…”