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Special Report
2005 American Society for Parenteral and Enteral Nutrition(A.S.P.E.N.) Standards and Guidelines Survey
David Seres, MD, CNSP; Charlene Compher, PhD, RD, FADA, LDN, CNSD;Douglas Seidner, MD, CNSP; Laura Byham-Gray, PhD, RD, CNSD;Jane Gervasio, PharmD, BCNSP; Stephen McClave, MD; and the A.S.P.E.N. Standards andGuidelines Committees
An online survey about the use and formatof the American Society for Parenteral and Enteral Nutri-tion (A.S.P.E.N.) Standards and Guidelines documentswas conducted. The survey was sent to A.S.P.E.N. mem-bers, and an acceptable number of responses werereceived (470, or 9% of those surveyed). Most respondentsindicated an overall satisfaction with the standards andguidelines and suggested format changes, many of whichwill be incorporated into future guidelines and standards.The results of this survey are presented here for generalinterest. Changes in the process with which A.S.P.E.N.produces standards and guidelines are discussed.
The American Society for Parenteral and EnteralNutrition (A.S.P.E.N.) has been publishing stan-dards and guidelines for over 20 years. Standardsare defined as benchmarks representing a range of performance of competent care that should be pro- vided to assure safe and efficacious nutrition care.
 A.S.P.E.N. has developed practice-based standards(eg, pediatric hospitalized patients or long-term carepatients) and discipline-specific standards (eg, die-titian, nurse, pharmacist, and physician).Clinical practice guidelines are systematicallydeveloped statements to assist practitioners withdecisions regarding practice and patient care issuesrelative to appropriate healthcare for specific clini-cal circumstances. For example, A.S.P.E.N. devel-oped adult and pediatric guidelines and safe prac-tices for parenteral nutrition.
See Table 1 for acomplete listing of current A.S.P.E.N. standards andguidelines.In 2005, the A.S.P.E.N. Board of Directorscharged the A.S.P.E.N. Guidelines Committee withcreating and implementing a mechanism to de- velop, revise, and publish evidence-based clinicalguidelines. The guidelines committee membersdecided that assessing the needs of the A.S.P.E.N.membership could provide them with informationon guideline use, complexity, and optimal format. At the same time, the A.S.P.E.N. Standards Com-mittee wished to better assess the frequency of useand utility of A.S.P.E.N. Standards. Thus, a joint A.S.P.E.N. Standards and Guidelines (S&G) surveywas developed.
 An online survey using the tool SurveyMonkey(SurveyMonkey.com LLC, Portland, OR) was devel-oped using closed- and open-ended questions. Thesequestions centered around 4 areas: demographics of the respondents, general questions about A.S.P.E.N.S&G, specific questions about the practice- anddiscipline-based standards, and specific questionsabout the guidelines. The survey was sent to the A.S.P.E.N. membership (n
e-mail in lateMay 2005. Because this survey was not rigorouslydeveloped, these data should not be construed asrobust, and the results of this survey are presentedhere only for general interest.
There were 470 respondents completing the sur- vey. This represents a response rate of 9% of the A.S.P.E.N. membership. Respondents were fairlyrepresentative of the distribution of disciplineswithin the membership of A.S.P.E.N. (Figure 1).Most respondents identified themselves primarily asclinicians. Administrators, researchers, and educa-tors each made up
7% of respondents. There was afairly even distribution of A.S.P.E.N membershipduration, that is, how long respondents had beensociety members, with about one-third of the respon-dents being relatively new (2 years or less).
Correspondence: Peggi A. Guenter, PhD, RN, 727 Homestead Avenue, Havertown, PA 19083. Electronic mail may be sent topeggig@aspen.nutr.org.
0884-5336/06/2105-0529$03.00/0Nutrition in Clinical Practice 21:529–532, October 2006Copyright © 2006 American Society for Parenteral and Enteral Nutrition
The largest percentage of respondents reportedtheir primary practice setting was a large academicmedical center or community hospital. About 10%named other practice areas such as industry, long-term acute-care facilities, physician offices, andambulatory infusion centers. The number of mem-bers responding from the home care setting (9.5%)was small, as was noted in the Safe Practices sur- vey
as well, and may indicate an opportunity foroutreach by A.S.P.E.N. to an underrepresented clin-ical area.Forty-four percent of respondents reported thatthere was a nutrition support team in their institu-tion, 51% reported no team, and 5% reported it notapplicable in their practice setting. In large aca-demic medical centers, respondents reported that63% had nutrition support teams, whereas in com-munity hospitals, only 28% had nutrition supportteams.
General Questions on A.S.P.E.N. S&G
Ninety-seven percent of respondents were awarethat A.S.P.E.N. publishes S&G. This may reflectthat either the S&G are widely known or that mostmembers unfamiliar with the S&G did not choose torespond to the survey. Most respondents reportedaccessing S&G through both the website and the journals. Approximately 60% of respondents accessS&G
the A.S.P.E.N. website and 88%
jour-nals. Few indicated purchasing S&G. This is notsurprising, because the target audience was A.S.P.E.N. members who have membership accessto the journals and website. The most commonlyused of the S&G were the 2002 clinical guidelines.
Discipline- and practice-based standards were usedby almost half or more of respondents (Figure 2).Only a small percentage of respondents (2.9%)reported using A.S.P.E.N. S&G in a legal proceed-ing; however, 5.6% of those respondents who have anutrition support team used these documents in alegal proceeding compared with 0.4% of those with-out a team. Even though only a small number of respondents reported use of these documents inlegal proceedings, this use has significant ramifica-tions. The percentages reported were based on thenumber of respondents and not number of legalcases and thus may underrepresent actual use.
Table 1
A.S.P.E.N. current standards and guidelines
StandardsStandards of practice: nutrition support nurse.
Nutr Clin Pract.
2001;16:56–62 (currently under revision).Standards of practice: nutrition support physician.
Nutr Clin Pract.
2003;18:270–275.Standards of practice: nutrition support pharmacist.
Nutr Clin Pract.
1999;14:275–281 (under revision).Standards of practice: nutrition support dietitian.
Nutr Clin Pract.
2000;15:53–59 (under revision).Standards for nutrition support: hospitalized adult patients.
Nutr Clin Pract.
2002;17:384–391.Standards for specialized nutrition support for adult residents of long-term care facilities.
Nutr Clin Pract 
. 2006;21:96–104.Standards for specialized nutrition support: home care patients.
Nutr Clin Pract.
2005;20:579–590.Standards for nutrition support: hospitalized pediatric patients.
Nutr Clin Pract.
2005;20:103–116.Definition of terms, style and conventions used in A.S.P.E.N. guidelines and standards.
Nutr Clin Pract.
2005;20:281–285.GuidelinesGuidelines for the use of parenteral and enteral nutrition in adult and pediatric patients.
JPEN J Parenter Enteral Nutr.
2002;26S(1 suppl):1SA–138SA. Errata: 2002;26:144.Safe practices for parenteral nutrition.
JPEN J Parenter Enteral Nutr.
2004;28:S39–S70. Erratum: 2006;30:177.
 Figure 1.
Respondent demographics
A.S.P.E.N. mem-ber demographics.
 Figure 2.
Use of A.S.P.E.N. standards and guidelines.Stds, standards.
Vol. 21, No. 5
Survey Results Pertaining to Standards
Respondents were generally satisfied with thecurrent format of the standards. Slightly over 50%were “somewhat satisfied,” 48.6% were “very satis-fied,” and
1% were “not at all satisfied.”Use of both the discipline-specific and practice-specific standards on a monthly basis was reportedby nearly half of respondents, whereas about one-fourth used them “daily” or “weekly” and anotherfourth used them “rarely or never.” The discipline-specific standards were used most commonly byindividuals for policy development, teaching, and forstudying for certification examinations (Figure 3).Respondents’ use of practice-based standards waswidely distributed between policy for patient care,quality improvement, support for specific patientrecommendations, and teaching (Figure 4).The opportunity for free-text responses was givenin several of the questions, but the responses weresimilar to the categories given. Of the total respon-dent pool, only 28 made additional comments andseveral were complimentary. Others requested moredetailed guidelines for specific situations, a requestthat may not be consistent with the intent of stan-dards. One respondent recommended the term
stan-dard of practice
always be used as opposed to
stan-dard of care
according to the concern for the legalimplications. A.S.P.E.N. currently uses the conceptterm
standards of practice
Survey Results Pertaining to the 2002Guidelines
The respondents reported that they used the 2002guidelines “daily14%, “weekly” 13%, “monthly”45%, and 29% said “rarely or never.” The guidelineswere used for the following specific purposes (usinga “check all that apply” answer format): 73% assupport for specific care recommendations, 59% indeveloping departmental policy for patient care,43% for quality improvement efforts, 32% for study-ing for a certification examination, and 5% for teach-ing students and other healthcare professionals(Figure 5). Respondents reported that their institu-tions use the guidelines for very similar purposes.Just over 40% of respondents believed the guide-lines improved patient care at their practice setting,whereas 5.4% did not and 44.4% were not sure. As tolevel of complexity of the guidelines, 80% indicatedthey were at the proper level of complexity, 16%noted they were too basic, and 4% of respondentsnoted they were too complicated.When rating the importance of specific features of the guidelines, the percent of respondents evaluat-ing a section as “extremely important” was as fol-lows: practice guidelines statements (61%), evidencereview (57%), grading of strength of evidence (45%),special considerations (36%), and background (27%).When asked if they used the primary referencescited in the guidelines, 65% said yes. The respon-dents overwhelmingly agreed (84%) that the guide-lines were organized such that they could easily findinformation they were seeking.When asked to rate how the following changesmight improve the guidelines format, 77% suggesteda searchable program on the website, 40% suggestedan index with more listings, and 35% indicated asearchable program on a compact disk wouldimprove the format. Forty-four percent suggested atext and tables format would greatly improve theguidelines, whereas 9% noted that a text-only for-mat was preferred. Free-text comments about theguidelines included a request to use more charts andtables and to have the guidelines on the A.S.P.E.N.website freely accessible to members of A.S.P.E.N.and nonmembers. Respondents entering free text
 Figure 3.
Use of A.S.P.E.N. discipline-specific standards.Cert exam, certification examination; Devel, development.
 Figure 4.
Use of A.S.P.E.N. practice-based standards.Cert exam, certification examination.
 Figure 5.
Use of A.S.P.E.N. 2002 guidelines.Cert exam, certification examination.
October 2006

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