Practice ordering guidance for neonatal parenteral nutrition

Objective: Neonatal parenteral nutrition (PN) is designed for very low birth weight infants (BW <= 1500 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.