Parenteral nutrition practice in the United States: A cross-sectional survey with gap analysis.

BACKGROUND

Parenteral nutrition is a high-alert medication with the potential for errors that result in patient harm. The American Society for Parenteral and Enteral Nutrition has published guidance to support safe parenteral nutrition practices; however, the current implementation of this guidance or improvement in clinical practice over time remains unknown.

METHODS

A cross-sectional survey on current parenteral nutrition practice was distributed to US-based clinicians. Survey items addressed multiple steps in the parenteral nutrition use process. Descriptive statistics were performed and presented as number and percentage of respondents.

RESULTS

A total of 1160 participants were included. Critical safety gaps included: prescribing practices that lack standardization and do not align with guidance; inadequate storage practices between compounding and administration; lack of adherence to specific filter type guidance; lack of adherence to the maximum hang time of separate lipid injectable emulsion infusions; limited oversight; minimal quality improvement activities; inadequate evaluation of errors; and pervasive unawareness of key institutional parenteral nutrition practices. Practice improvements included greater adoption of safety technologies and an increased use of filters during administration.

CONCLUSION

This survey of current parenteral nutrition practice reveals some improvements in clinical practice; however, it highlights several critical gaps in the adoption of guidance with ongoing unsafe practices, which can result in patient harm.