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

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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.

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