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  • Original Article
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Practice ordering guidance for neonatal parenteral nutrition

Abstract

Objective:

Neonatal parenteral nutrition (PN) is designed for very low birth weight infants (BW1500 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.

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Acknowledgements

We acknowledge research support of the Allen Foundation, Midland, MI, and the statistical and editorial assistance of Michael O'Shea, MD and Robert Dillard, MD. We thank the participating evaluators of the paper parenteral nutrition order forms and the participating institutions who provided information and copies of their paper neonatal parenteral nutrition order forms (location), Institution: (Asheville) Mission Memorial Hospital, (Chapel Hill) University of North Carolina Hospitals, (Charlotte) Carolinas Medical Center, (Charlotte) Presbyterian Healthcare, (Durham) Duke University Hospital, (Greensboro) The Women's Hospital of Greensboro, (Greenville) East Carolina University, (Wilmington) New Hanover Regional Medical Center, (Winston-Salem) North Carolina Baptist Hospital.

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Correspondence to P J Porcelli.

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Porcelli, P. Practice ordering guidance for neonatal parenteral nutrition. J Perinatol 27, 220–224 (2007). https://doi.org/10.1038/sj.jp.7211672

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