Seres David, Sacks Gordon S, Pedersen Craig A, Canada Todd W, Johnson Deborah, Kumpf Vanessa, Guenter Peggi, Petersen Craig, Mirtallo Jay
Beth Israel Medical Center and Albert Einstein College of Medicine, New York, New York, USA.
JPEN J Parenter Enteral Nutr. 2006 May-Jun;30(3):259-65. doi: 10.1177/0148607106030003259.
The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recently published a revision of its "Safe Practices for Parenteral Nutrition" guidelines. Because there is a paucity of published scientific evidence to support good practices related to ordering, compounding, and administering parenteral nutrition (PN), a survey was performed in the process of the revision to gain insight into the discrepancies between reported practices and previous guidelines.
A web-based survey consisting of 45 questions was conducted (n = 651) June 1-30, 2003. Respondents were queried about primary practice setting, professional background, processes for writing PN orders, computer order entry of PN orders, problems with PN orders, and adverse events related to PN.
There were 651 survey responses, 90% of which were from hospital-based practitioners. Almost 75% of responders processed between 0 and 20 PN orders per day. Overall, physicians (78%) were responsible for writing PN orders, but dietitians and pharmacists had significant involvement. PN base components were most often ordered as percentage final concentration after admixture (eg, 20% dextrose), which is inconsistent with safe practice guidelines of ordering by total amount per day (eg, 200 g/day). There was no consistent method for ordering PN electrolytes. Approximately 45% of responders reported adverse events directly related to PN that required intervention. Of these events, 25% caused temporary or permanent harm, and 4.8% resulted in a near-death event or death.
Although the survey found consistency in PN practices for many areas queried, significant variation exists in the manner by which PN is ordered and labeled.
美国肠外肠内营养学会（A.S.P.E.N.）最近发布了其《肠外营养安全实践》指南的修订版。由于缺乏已发表的科学证据来支持与肠外营养（PN）的医嘱开具、配制和给药相关的良好实践，因此在修订过程中进行了一项调查，以深入了解报告的实践与先前指南之间的差异。
2003年6月1日至30日进行了一项基于网络的调查，该调查包含45个问题（n = 651）。询问了受访者的主要执业环境、专业背景、PN医嘱的开具流程、PN医嘱的计算机录入、PN医嘱的问题以及与PN相关的不良事件。
共收到651份调查回复，其中90%来自医院从业者。近75%的受访者每天处理0至20份PN医嘱。总体而言，医生（78%）负责开具PN医嘱，但营养师和药剂师也有重要参与。PN基础成分最常按混合后的最终浓度百分比开具医嘱（例如，20%葡萄糖），这与按每日总量开具医嘱的安全实践指南（例如，200克/天）不一致。开具PN电解质没有一致的方法。约45%的受访者报告了与PN直接相关且需要干预的不良事件。在这些事件中，25%造成了暂时或永久性伤害，4.8%导致了濒死事件或死亡。
尽管调查发现许多被询问领域的PN实践具有一致性，但PN的医嘱开具和标签标注方式仍存在显著差异。
