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Definition of Terms

Definition of Terms, Style, and Conventions Used in A.S.P.E.N. Board of Directors– Approved Documents

American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors and Clinical Practice Committee

Clinical Practice Committee (2008-2009 and 2009-2010)

Beverly J. Holcombe, PharmD, BCNSP, FASHP and Kris M. Mogensen, MS, RD, LDN, CNSD (Chairpersons); Lillian P. Harvey Banchik, MD, CNSP, FACS; Gary D. Brooks, PharmD, BCPS; Bryan Collier, DO, CNSP; Coryn E. Commare, MS, RD, LD, CNSD; Ann Beemer Cotton, MS, RD, CNSD; Irna de Leon-Knapp, RD, LDN, CNSC; Deborah R Houston, PharmD, BCNSP; Paula F. Johns, RN, CNSN; Jeanette N. Keith, MD; Marty Kochevar, MS, RPh, BCNSP; Debra S. Kovacevich, MPH, RN; Jay Mirtallo, MS, RPh, BCNSP, FASHP; Dominic N. Reeds, MD; Melanie H. Shuster, PhD, APRN, CNSN; and Abby Wood, RD, LD, CNSD

The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) is a professional society of physicians, nurses, dietitians, pharmacists, allied health professionals, and researchers. A.S.P.E.N. envisions an environment in which every patient receives safe, efficacious, and high quality patient care. A.S.P.E.N.’s mission is to improve patient care by advancing the science and practice of nutrition support therapy.

These definitions include many terms which were defined in the 19951 and 20052 definitions documents along with additional terms which were defined in the 2004 Safe Practices for Parenteral Nutrition3 document, the 2007 Statement on Parenteral Nutrition Standardization,4 and the 2009 Enteral Nutrition Practice Recommendations.4 This Definition of Terms, Style and Conventions paper shall be used in conjunction with all A.S.P.E.N Board of Directors–approved documents including the following: Standards of Practice, Clinical Guidelines, Position and White Papers, and Bundles. [See A.S.P.E.N. Documents Library at http://www.nutritioncare.org/Library.aspx ]

A.S.P.E.N. Board of Directors–approved Documents (terms and definitions)

Standards: Benchmarks representing a range of performance of competent care that should be provided to assure safe and efficacious nutrition care. Standards are documents that define the structure needed to provide competent care. They usually address professional responsibilities as they relate to patient assessment, diagnosis, education, care plan development, implementation, clinical monitoring, evaluation, and professional issues. A.S.P.E.N. publishes discipline-based (e.g., dietitian, nurse, pharmacist, or physician) and practice-based (e.g., adult hospitalized patients, pediatric hospitalized patients, home care, long-term care) standards. Standards are presented in the most generic terms possible. The details of specific tests, therapies, and protocols are left to the discretion of individual healthcare facilities. The Standards aim to assure sound and efficient nutrition care for those in need of nutrition support therapy.5 The application of Standards is always subject to the judgment of the professional as applied to the individual case.

Clinical Guidelines: Systematically-developed statements to assist practitioner and patient decisions about appropriate nutrition care for specific clinical circumstances. Clinical Guidelines define the role of specific diagnostic and treatment modalities in the diagnosis and management of patients. Clinical Guidelines contain recommendations that are based on evidence from a rigorous systematic review and evaluation of the published medical literature.6 These Guidelines may include categories outlined by the National Guideline Clearinghouse™ such as screening, evaluation, assessment of therapeutic effectiveness, diagnosis, management, rehabilitation, risk assessment, prevention, counseling, technology assessment, or treatment relating either to a specific disease or condition or to a therapy.7  The application of Clinical Guidelines is always subject to the judgment of the professional as applied to the individual case.

Position Paper:  A document that presents the official opinion of A.S.P.E.N. on a particular topic. These papers include a comprehensive review of the literature supporting the position taken.8

White Paper:  An authoritative report or guide that often addresses problems and how to solve them.9 White papers are used to educate readers and help people make decisions, but do not include a direct opinion or position on the topic.

Bundle: A structured method of improving the processes of patient care and patient outcomes. This is typically implemented as a small set of specific practices (3-5) that have been proven to improve outcomes when performed together and reliably.10

Definition of Terms

The following terms are used in A.S.P.E.N. documents approved by the Board of Directors:

Administer: The act of delivering substance(s) to an individual by a prescribed dosage and route.

Administration: The physical delivery of substance(s) to individuals.

Admixture: The result of combining 2 or more fluids.

Adolescent: 11 years to 21 years of age.11

Adverse Event:  Any incident in which the use of a medication (drug or biologic) at any dose, a medical device, or a special nutrition product (for example, dietary supplement, infant formula, medical food) may have resulted in an untoward, undesirable, and usually unanticipated outcome in a patient. (adapted from Sentinel Event Glossary of Terms, The Joint Commission12)

Automated Compounding Device: A device that compounds parenteral preparations. When relating to parenteral nutrition, it transfers large-volume parenterals such as dextrose, amino acids, fat emulsion, and sterile water, as well as small-volume parenterals including electrolytes, minerals, and vitamins to the final parenteral nutrition container. (adapted from Safe Practices for Parenteral Nutrition3)

Beyond-Use Date:

  • (parenteral): The date or time after which a compounded sterile preparation shall not be stored or transported. The date is determined from the date or time the preparation is compounded.13

  • (enteral): The date established by healthcare professionals recommended in the published literature or manufacturer-specific recommendations beyond which the facility-prepared product should not be used. This definition also includes closed enteral feeding systems that do not require facility preparation, but for which the manufacturer’s expiration date is no longer valid once the product is spiked with an enteral administration set. (adapted from Enteral Nutrition Practice Recommendations4)

Birth Weight: First weight of the fetus or newborn obtained after birth.14

  • Low Birth Weight: weight of less than 2500 g (up to and including 2499 g).

  • Very Low Birth Weight: weight of less than 1500 g.

  • Extremely Low Birth Weight: weight of less than 1000 g.

Body Weight: [see Weight]

Cachexia: A complex metabolic syndrome associated with underlying illness and characterized by loss of muscle with or without loss of fat mass. The prominent clinical feature of cachexia is weight loss in adults (corrected for fluid retention) or growth failure in children (excluding endocrine disorders). Anorexia, inflammation, insulin resistance, and increased muscle protein breakdown are frequently associated with cachexia.15 *
* Note: This is an interim definition pending the development of a consensus with A.S.P.E.N. collaborators.

Calorie: In metabolic studies, the Calorie (equivalent to 1000 calories or 1 kilocalorie [kcal]) is the amount of heat energy required to raise or lower 1 kg of pure liquid water by 1°C. The Calorie is used in nutrition to express the energy content of food.16 Calorie should only be used in the quantification of energy. [also see Energy]

Care Plan: Design (or scheme) of professional clinical activities developed to implement and achieve treatment goals.

Child: 12 months to 11 years of age.11

Closed Enteral System: A closed enteral container pre-filled with sterile, liquid formula by the manufacturer which is considered ready to hang.17

Compatibility: The ability to combine 2 or more products such that the physical integrity and stability of each product is not altered when combined. By contrast, incompatibility refers to the physical alteration of a product when combined with 1 or more other products as a result of concentration or temperature-dependent reactions (e.g., precipitation) that can alter activity or stability. (adapted from Safe Practices for Parenteral Nutrition3)

Computerized Prescriber Order Entry: An electronic clinical information system in which the prescriber enters orders directly into a computer. (adapted from Safe Practices for Parenteral Nutrition3)

DEHP: di (2-ethylhexyl) phthalate, a plasticizer used in various intravenous administration sets or plastic infusion bags.3

Diet: A prescribed allowance of food or nutrients provided via the oral route.

  • Regular Diet or Normal Diet: “a full, well-balanced diet containing all of the essential nutrients needed for optimal growth, tissue repair, and normal functioning of the organs. Such a diet contains foods rich in proteins, carbohydrates, high-quality fats, minerals, and vitamins in proportions that meet the specific caloric requirements of the individual.”18

  • Therapeutic Diet: A diet used as part of a treatment of a disease or clinical condition to eliminate, decrease, or increase certain substances in the diet. (adapted from Nutritional Deficiencies in Long-term Care, Part III: OBRA Regulations and Administrative and Legal Issues,19 and Liberalization of the Diet Prescription Improves Quality of Life for Older Adults in Long-term Care [American Dietetic Association]20)

Dosing Weight: A patient-specific weight determined and used by the clinician to arrive at a specific nutrient dose. Determination of dosing weight is dependent on institutional or professional preference; the dosing weight may be the actual, ideal, or adjusted body weight of the individual.

Drug-Drug Interaction: A pharmacokinetic or pharmacodynamic interaction between 2 or more drugs that might result in a therapeutic, subtherapeutic, or supratherapeutic clinical response.

Drug-Nutrient Interaction: An event that results from a physical, chemical, physiologic, or pathophysiologic relationship between a drug and nutrient status, nutrient(s), or food in general, which is clinically significant if drug response is altered or nutrition status is compromised. (adapted from An Approach to Evaluating Drug-nutrient Interactions21)

Energy: Required to sustain the body’s various functions by oxidation (primarily carbohydrates, fats, and amino acids), yielding the chemical energy needed to sustain metabolism, nerve transmission, respiration, circulation, and physical work. [also see Calorie]
(adapted from Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients)22)

Enteral Access Device: Tube placed directly into the gastrointestinal tract for the delivery of nutrients and/or drugs.

Enteral Misconnection: An inadvertent connection between an enteral feeding system and a non-enteral system such as an intravascular line, peritoneal dialysis catheter, tracheostomy, medical gas tubing, etc.23

Enteral Nutrition: Feeding provided through the gastrointestinal tract via a tube, catheter, or stoma that delivers nutrients distal to the oral cavity.

Expiration Date:

  • (foods): The calendar date on the packaging of a food that indicates the last date a food should be eaten or used.24

  • (drugs): Identifies the time during which the drug product may be expected to meet the requirements of the compendial monograph, provided it is kept under the prescribed storage conditions; limits the time during which the article may be dispensed or used. Where an expiration date is stated only in terms of the month and year, it is a representation that the intended expiration date is the last day of the stated month. (adapted from United States Pharmacopeia. General Notices and Requirements 25)

Formulation: A mixture of nutrients suitable for administration to a patient.

Geriatric: An adult 65 years of age or greater.26

Hang Time: The length of time a formulation is considered safe for administration to the patient beginning with the time the formulation has been compounded, reconstituted, warmed, decanted, or has had the original package seal broken. (adapted from Enteral Nutrition Practice Recommendations4)

Indicators: Prospectively-determined measures used as normative standards within a performance improvement process.

Infant: Prenatal to 12 months of age.11

Intravenous Fat Emulsion: An intravenous oil-in-water emulsion of oils(s), egg phosphatides, and glycerin. The term should be used in preference to lipids.3

Macronutrient: Nutrients that are required in relatively large amounts and can be metabolized to produce energy (carbohydrates, proteins, fats).

Malnutrition: A subacute or chronic state of nutrition, in which a combination of varying degrees of overnutrition or undernutrition and inflammatory activity has led to a change in body composition and diminished function.27 *
* Note: This is an interim definition pending the development of a consensus with A.S.P.E.N. collaborators.

Medical Food: "…a food which is formulated to be consumed or administered enterally under the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation"28 as defined in section 5(b) of the Orphan Drug Act (21 U.S.C. 360ee (b) (3)).

Medical Nutrition Therapy:

  • Two phases of (a) assessment of the nutrition status of the patient or client, and (b) treatment which includes diet therapy, counseling, or use of specialized nutrition supplements. The services of qualified health professionals are provided in a variety of settings, including inpatient and outpatient services (e.g., consultations provided in a home, office, school, ambulatory or institutional setting). (adapted from Identifying Patients at Risk: ADA’s Definitions for Nutrition Screening and Nutrition Assessment 29)

  • (Pertaining to reimbursement of services) Nutrition diagnostic, therapeutic, and counseling services provided by a registered dietitian or nutrition professional for the purpose of managing diabetes or a renal disease. (adapted from Medicare Program; Revisions to Payment Policies and Five-year Review of and Adjustments to other Relative Value Units under the Physician Fee Schedule Calendar for Year 200230)

Micronutrient: Nutrients present and required in the body in minute quantities (e.g., vitamins, trace elements).

Minimum Data Set: Part of the federally mandated process for clinical assessment of all residents in Medicare- or Medicaid-certified nursing homes. This process provides a comprehensive assessment of each resident's functional capabilities and helps nursing home staff identify health problems. Resident Assessment Protocols are part of this process, and provide the foundation upon which a resident's individual care plan is formulated.31

Modular Enteral Feeding: Formulation created by combination of separate nutrient sources or by modification of existing formulations.

Multi-Chamber Bag: A container designed to promote extended stability of a parenteral nutrition formulation by separating some components (e.g., intravenous fat emulsion) from the rest of the formulation. It consists of 2 or more chambers separated by a seal or tubing that is clamped. At the time of administration, the seal or clamp is opened to allow the contents of the chambers to mix and create an admixture. (adapted from Safe Practices for Parenteral Nutrition3)

Neonate: An infant during the first month of life.11

Nutrient: Protein, carbohydrate, lipid, vitamins, minerals, or water.

Nutrition: The sum of processes by which one takes in and utilizes nutrients.

  • Nutrition vs Nutritional:

    • Nutrition: Of or relating to the state of nutrition or things related to the field of nutrition. Can be used as a compound structure with terms such as nutrition support, nutrition nurse, nutrition team, nutrition program, etc.

    • Nutritional: Usually that which has nutrient value, such as nutritional cereal, nutritional meal, and so on.

Nutrition Assessment: A comprehensive approach to diagnosing nutrition problems that uses a combination of the following: medical, nutrition, and medication histories; physical examination; anthropometric measurements; and laboratory data.

Nutritionally-at-Risk Neonates: Neonates should be considered at nutrition risk if they have any of the following:

  • Low birth weight (<2500 g) even in the absence of gastrointestinal, pulmonary, or cardiac disorders. 32

  • Birth weight greater than 2 standard deviations below the mean (approximately the 3rd percentile) for gestational age on fetal weight curves.

  • Acute weight loss of 10% or more.

Nutritionally-at-Risk Children: Children should be considered at nutrition risk if they have any of the following:

  • A weight for length or weight for height or sex less than the 10th percentile or greater than the 95th percentile.31

  • Body mass index for age or sex less than 5th percentile or greater than the 85th percentile.33

  • Increased metabolic requirements.30

  • Impaired ability to ingest or tolerate oral feedings.30

  • Documented inadequate provision of or tolerance of nutrients. 30

  • Inadequate weight gain or a significant decrease in usual growth percentile. 30

Nutritionally-at-Risk Adults: Adults may be considered at nutrition risk if they have any of the following:

  • Involuntary loss of ≥10% of usual body weight within 6 months, or involuntary loss of ≥5% of usual body weight in 1 month.34

  • Involuntary loss or gain of 10 pounds within 6 months.35

  • Body mass index less than 18.5 kg/m2 or greater than 25 kg/m2.36

  • Chronic disease.30

  • Increased metabolic requirements.30

  • Altered diets or diet schedules. 30

  • Inadequate nutrition intake, including not receiving food or nutrition products for greater than 7 days.37

Nutrition Care: Interventions, monitoring, and evaluation designed to facilitate appropriate nutrient intake based upon the integration of information from the nutrition assessment.

Nutrition Care Plan: A formal statement of the nutrition goals and interventions prescribed for an individual using the data obtained from a nutrition assessment. The plan should include statements of nutrition goals and monitoring/evaluation parameters, the most appropriate route of administration of nutrition therapy, method of nutrition access, anticipated duration of therapy, and training and counseling goals and methods.

Nutrition Screening: A process to identify an individual who may be malnourished or at risk for malnutrition to determine if a detailed nutrition assessment is indicated.

Nutrition Support Process: The assessment, diagnosis, ordering, preparation, distribution, administration, and monitoring of nutrition support therapy.

Nutrition Support Service (or Team): An interdisciplinary group which may include physicians, nurses, dietitians, pharmacists, and/or other healthcare professionals with expertise in nutrition who manage the provision of nutrition support therapy.

Nutrition Support Specialist: A healthcare professional with specialized training and/or experience in nutrition support therapy. The specialized training may include independent or formalized education endeavors. Specialists may be recognized with specialty certification.

Nutrition Support Therapy: Parenteral and/or enteral nutrition.

Nutrition Therapy: A component of medical treatment that includes oral, enteral, and parenteral nutrition.

Open Enteral System: A feeding system in which the clinician/patient/caregiver is required to decant formula into the enteral container. (adapted from Enteral Nutrition Practice Recommendations4)

Osmolality: The measured osmotic concentration of a liquid expressed in osmoles or milliosmoles per kilogram of solvent (Osmol per kg or mOsmol per kg, respectively). Osmolality is a measure of the osmotic pressure exerted by a liquid across a semipermeable membrane. (adapted from USP <785> Osmolality and Osmolarity38)

Osmolarity: The theoretical, calculated osmotic concentration of a liquid expressed in osmoles or mOsmol per liter of a solution; used in clinical practice because it expresses osmoles as a function of volume. Osmolarity cannot be measured, only calculated. (adapted from USP <785> Osmolality and Osmolarity39)

Outcome: The measured result of the performance of a system or process.

Oral Nutrition: Nutrients taken by mouth.

Parenteral Nutrition: The intravenous administration of nutrients.

  • Central: Parenteral nutrition delivered into a large-diameter vein, usually the superior vena cava adjacent to the right atrium.

  • Peripheral: Parenteral nutrition delivered into a peripheral vein, usually of the hand or forearm.3

Pediatrics: Includes the growth, development, and health of the child and therefore begins in the period before birth when conception is apparent. It continues through childhood and adolescence when the growth and developmental processes are generally completed. The responsibility of pediatrics therefore may begin during pregnancy and usually terminates by 21 years of age.39

Pharmacodynamics: The study of the biological effects resulting from the interaction between drugs and biological systems.40

Pharmacokinetics: The study of the absorption, distribution, metabolism, and elimination of drugs in patients.41

Preparation: A food, drug, or dietary supplement (or mixtures thereof) compounded in a licensed pharmacy or other healthcare-related facility pursuant to the order of a licensed prescriber. (adapted from USP <797> Pharmaceutical Compounding—Sterile Preparations13)

Product: A commercially-manufactured food, drug, or dietary supplement. Drug products are accompanied by full prescribing information, which is commonly known as the Food Drug Administration-approved manufacturer’s labeling or product package insert. (adapted from USP <797> Pharmaceutical Compounding—Sterile Preparations13)

Sentinel Event: An unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase “or the risk thereof” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome.42

Stability: The extent to which a product retains, within specified limits and throughout its period of storage and use (i.e., its shelf-life), the same properties and characteristics that it possessed at the time of its manufacture.3

Standardized, Commercial Parenteral Nutrition Product: A standardized parenteral nutrition formulation available from a manufacturer and requiring fewer compounding steps before administration. Current examples of these products are concentrated amino acids (with or without electrolytes) plus concentrated dextrose containers or multichamber bags of these products, often called premixed solutions.4

Standardized Parenteral Nutrition Formulation: A parenteral nutrition formulation intended to meet the daily maintenance requirements of a specific patient population (e.g., age-, stress-, or disease state–specific) and differentiated by route of administration (central vs peripheral vein).4

Total Nutrient Admixture: A parenteral nutrition formulation containing intravenous fat emulsion as well as the other components of parenteral nutrition (dextrose, amino acids, vitamins, minerals, water, and other additives) in a single container.3

Transitional Feeding: Progression from one mode of feeding to another.

Vascular Access Device: Catheter placed directly into the arterial or venous system for infusion therapy and/or phlebotomy. (adapted from Safe Practices for Parenteral Nutrition3)

Weight / Body Weight: Actual, measured body weight of an individual. The use of other body weights must be defined by the author(s). (see Dosing Weight)

Style, Symbols, and Abbreviations

The following style, symbols, and abbreviations lists are used in all A.S.P.E.N. documents and publications to (1) promote consistency among the A.S.P.E.N. Standards and Clinical Guidelines documents and publications; and (2) promote consistency with national recommendations regarding patient safety including those produced by The Joint Commission and the Institute for Safe Medication Practices (ISMP) (Tables 1 through 5).

Style Convention

1. The units of the International System of Units (SI) [e.g., metric system] and those units recognized for use with the SI are preferred to express the values of quantities. Equivalent values in other units may be used only when deemed necessary for the intended audience, e.g., kcal instead of joule. (adapted from International System of Units (SI) rules and style conventions43)

2. Place a space between the numerical value and unit symbols (e.g., 25 mg, never 25mg).44,44

3. Do not use trailing zeros for integers (e.g., 5 mg, never 5.0 mg).45,45 Exception: A “trailing zero” may be used only where required to demonstrate the level of precision of the value being reported, such as for laboratory results, imaging studies that report size of lesions, or catheter/tube sizes.45

4. Always use leading zeros for numerical values less than 1 (e.g., 0.3, never .3).45,46 Exception: certain statistical values such as α levels or P values, should be reported without the use of 0 before the decimal marker.17

5. Unit symbols are unaltered in the plural (e.g., 175 cm, never 175 cms).44

6. Unit symbols are not followed by a period unless at the end of a sentence (e.g., 175 cm, never 175 cm.).44,45

7. Information is not mixed with unit symbols or names (e.g., “the water content is 20 mL/kg” never
“20 mL H2O/kg” or “20 mL of water/kg”).44

8. Express drug products by generic name (use lowercase letters) as the primary drug nomenclature, ensuring that each matches Food and Drug Administration (FDA) or United States Pharmacopeia (USP)-approved nomenclature. Do not abbreviate drug names.45 Do not use slang or stem names (e.g., “intravenous fat emulsion” never “lipids”).

9. Do not use proprietary, commercial trade names unless both of the following criteria are met: 1) Use of the trade name is essential for the reader to distinguish among similar products for clinical or research purposes, and 2) Specific evidence is provided to document or contrast the use of one product vs another similar product. If a trade name is used, begin the trade name with a capital letter and include the appropriate legal symbol (e.g., ©, ®, or ™).

10. Use only standard abbreviations; use of nonstandard abbreviations can be confusing to readers. Avoid abbreviations in the title of the manuscript. The spelled-out abbreviation followed by the abbreviation in parenthesis should be used on first mention unless the abbreviation is a standard unit of measurement. 46 

Table 1: Acceptable symbols (units of measure)a 

Symbol

Name

Symbol

Name

kcal

Kilocalorie

Eq

Gram-equivalent weight

g

Gram

mEq

Milliequivalent

kg

Kilogram

mol

Gram-molecular weight

mg

Milligram

mmol

Millimole

mcgb

Microgramb

Osm or Osmol

Osmole

ng

Nanogram

mOsm or mOsmol

Milliosmole

pg

Picogram

s

Second

L

Liter

min

Minute

dL

Deciliter

h

Hour

mL

Milliliter

d

Day

m

Meter

mo

Month

dm

Decimeter

y

Year

cm

Centimeter

°C

Degree Celsius

mm

Millimeter

 

 

aAll symbols from National Institute of Standards and Technology 47 or USP48.
bThe μg symbol is acceptable in the scientific literature; however, ISMP45 and The Joint Commission46 recommend that mcg be used to avoid confusion with mg.

Table 2:  Acceptable symbol prefixes48

Symbol

Name and factor

Symbol

Name and factor

G

giga; 109

d

deci; 10-1

M

mega; 106

c

centi; 10-2

k

kilo; 103

m

milli; 10-3

h

hecto; 102

mca

micro; 10-6

da

deka; 101

n

nano; 10-9

aThe mu (μ) symbol is acceptable in the scientific literature; however, ISMP45 and The Joint Commission46 recommend that μ not be used (e.g., mcg should be used to avoid confusion with mg).

Table 3:  Non-acceptable symbols45,46

Symbol

Intended Meaning

Misinterpretation

Correction

cc

Cubic centimeter

Misread as “U” or “4”

Note:  cm3 is SI nomenclature

mL for fluid volumes or cm3 for solid volumes

U or u

Unit

Mistaken as the number 0 or 4

Spell out “unit”

μg

Microgram

Confusion with mg

mcg

IU

International Unit

Confusion with IV

Spell out International Unit (or Unit as appropriate)

Table 4 Acceptable abbreviations*

Term

Intended Meaning

Term

Intended Meaning

A.S.P.E.N.

American Society for Parenteral and Enteral Nutrition

IVFE

Intravenous fat emulsion

AGA

Appropriate for gestational age

LBM

Lean body mass

AI

Adequate intake

LBW

Low birth weight

BEE

Basal energy expenditure

LGA

Large for gestational age

BMI

Body mass index

NRI

Nutritional risk index

BMR

Basal metabolic rate

PCM

Protein-calorie malnutrition

BUD

Beyond use date

PICC

Peripherally inserted central catheter

CPN

Central parenteral nutrition

PINI

Prognostic inflammatory and nutritional index

CQI

Continuous quality improvement

PN

Parenteral nutrition

DRI

Dietary reference intake

PNI

Prognostic nutrition index

EAR

Estimated average requirement

PPN

Peripheral parenteral nutrition

EER

Estimated energy requirement

RDA

Recommended dietary allowance

ELBW

Extremely low birth weight

REE

Resting energy expenditure

EN

Enteral nutrition

RMR

Resting metabolic rate

FDA

Food and Drug Administration

RNI

Recommended nutrient intake

FFA

Free fatty acids

RQ

Respiratory quotient

FFM

Fat free mass

SDA

Specific dynamic action

FTT

Failure to thrive

SGA

Small for gestational age, or
Subjective global assessment

GI

Gastrointestinal

SVC

Superior vena cava

HBM

Human breast milk

TEE

Total energy expenditure

HEN

Home enteral nutrition

TNA

Total nutrient admixture

HPN

Home parenteral nutrition

UL

Tolerable upper intake level

IBW

Ideal body weight

USP

United States Pharmacopeia

IDPN

Intradialytic parenteral nutrition

VLBW

Very low birth weight

IUGR

Intrauterine growth restriction

 

 

*Note: The full term which an abbreviation represents should precede its first use in the text.
  This table only includes abbreviations specific to nutrition support therapies.

Table 5 Unacceptable abbreviations

Symbol

Intended Meaning

Misinterpretation

Correction

HA, HAL

Hyperalimentation

Antiquated term for parenteral nutrition; unclear as to “hyper” amount of nutrients or hypertonic solutions

PN, CPN, or PPN

HAS

Hyperalimentation solution

[See HA, HAL]

PN, CPN, or PPN

MVI

Multivitamin

MVI is a registered trademark for “Multi-Vitamin Infusion”

Spell out use

NCP

Nutrition Care Plan vs American Dietetic Association’s “Nutrition Care Process” vs Nutrition in Clinical Practice (A.S.P.E.N. journal)

Unclear as to which term

Spell out use

NST

Nutrition Support Team vs Nutrition Support Therapy

Unclear as to which term

Spell out use

PEN

Parenteral/enteral nutrition

Combination term unclear when meaning one or the other therapy

PN or EN

SNS

Specialized Nutrition Support

This term and Artificial Nutrition Therapy are no longer to be used in A.S.P.E.N. documents

Nutrition Support Therapy

TJC

The Joint Commission

“Officially, The Joint Commission does not use this abbreviation.  There have been some exceptions, e.g., the social media realm where character space limitations exist.”a

Spell out full title

TPN

Total parenteral nutrition

Unclear as to total nutrients in formulation or totally by parenteral route

PN, CPN, or PPN

a Frank Barancyk, October 6, 2009, personal communication, Internet/Intranet Communications Manager, Communications, The Joint Commission.

References:

1  A.S.P.E.N. Board of Directors. Definitions of terms used in A.S.P.E.N. guidelines and standards. Nutr Clin Pract. 1995;10(1):1-3.

2  A.S.P.E.N. Board of Directors and Standards Committee.  Definitions of terms, style, and conventions used in A.S.P.E.N. guidelines and standards.  Nutr Clin Pract. 2005;20(2):281-285.

3  Mirtallo J, Canada T, Johnson D, et al: Task Force for the Revision of Safe Practices for Parenteral Nutrition. Safe practices for parenteral nutrition (Erratum in: JPEN J Parenter Enteral Nutr. 2006;30(2):177.). JPEN J Parenter Enteral Nutr. 2004;28(6): S39–S70.

Bankhead R, Boullata J, Brantley S, et al; A.S.P.E.N. Board of Directors.  Enteral nutrition practice recommendations. JPEN J Parenter Enteral Nutr. 2009;33(2):122-167.

5  A.S.P.E.N. Board of Directors. A.S.P.E.N. Standards Policy. Internal Board Document. 2008.

6  Committee to Advise the Public Health Service on Clinical Practice Guidelines. Institute of Medicine. Clinical Practice Guidelines:  Directions for a New Program. Washington, DC: National Academy Press;1990:38.

7  National Guideline Clearinghouse. Glossary. Agency for Healthcare Research and Quality. http://www.guideline.gov/submit/glossary.aspx. Modified November 2, 2009. Accessed November 6, 2009.

8  United Nations Association of the United States of America. Position papers, model UN preparation guide.  http://www.unausa.org/Page.aspx?pid=521. Accessed November 6, 2009.

9  Stelzner MA.  How to write a white paper—a white paper on white papers. Stelzner Consulting. http://www.stelzner.com/copy-HowTo-whitepapers.php. Published 2009. Accessed November 6, 2009.

10  Haraden C.  What is a bundle? Institute for Healthcare Improvement. http://www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare/ImprovementStories/WhatIsaBundle.htm. Published September 7, 2006. Accessed November 6, 2009.

11  Committee on Practice and Ambulatory Medicine, Bright Futures Steering Committee. Recommendations for preventive pediatric health care. American Academy of Pediatrics web site. http://aappolicy.aappublications.org/cgi/content/full/pediatrics;105/3/645. Revised December 1, 2007. Accessed November 6, 2009.

12  The Joint Commission. Sentinel event glossary of terms.  Available at: http://www.jointcommission.org/SentinelEvents/se_glossary.  Accessed November 5, 2009.

13  Pharmaceutical compounding—sterile preparations (general information chapter 797). In: The United States Pharmacopeia, 30th rev., and The National Formulary, 25th ed. Rockville, MD: The United States Pharmacopeial Convention; 2007:334-51.

14  World Health Organization Statistical Information System (WHOSIS). Indicator definitions and metadata, 2008. World Health Organization web site. http://www.who.int/whosis/indicators/compendium/2008/2bwn/en/. Accessed November 6, 2009.

15  Evans WJ, Morley JE, Argiles J, et al. Cachexia: a new definition. Clin Nutr. 2008; 27(6):793-799.

16 American Medical Association. AMA Manual of Style: A Guide for Authors and Editors, 10th ed. New York, NY: Oxford University Press; 2007.

17  Hsu TC, Chen NR, Sullivan MM, et al. Effect of high ambient temperature on contamination and physical stability of one-liter ready-to-hang enteral delivery systems. Nutrition. 2000;16(3):165-167.

18  Mosby's Medical Dictionary, 8th ed.  Regular diet. The Free Dictionary. http://medical-dictionary.thefreedictionary.com/regular+diet. Accessed November 6, 2009.

19  Thomas ER, Kamel H, Morley JE. Nutritional deficiencies in long-term care, Part III: OBRA regulations and administrative and legal issues. Annals of Long-Term Care: Clinical Care and Aging. 1998;6(10):325-332.

20  American Dietetic Association. Position of the American Dietetic Association: liberalization of the diet prescription improves quality of life for older adults in long-term care. J Am Diet Assoc. 2005; 105(12):1955-1965.

21  Santos CA, Boullata JI. An approach to evaluating drug-nutrient interactions. Pharmacotherapy. 2005;25(12):1789-1800.

22 Panel on Macronutrients, Food and Nutrition Board, Institute of Medicine. Energy. In: Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients). Washington DC: National Academies Press; 2005:107-264. http://books.nap.edu/catalog.php?record_id=10490. Accessed November 10, 2009.

23  Guenter P, Hicks RW, Simmons D, et al. Enteral feeding misconnections: a consortium position statement. Jt Comm J Qual Patient Saf. 2008;34(5):285-292.

24  FDA-CFSAN.  The A to Z Comprehensive list of terms.  Galveston County Health District web site. http://www.gchd.org/NFSEM/a2z-term.html. 2007 edition.  Accessed November 10, 2009.

25  United States Pharmacopeia. General Notices and Requirements, USP 32.  http://www.usp.org/pdf/EN/USPNF/generalNoticesandRequirementsFinal.pdf. Official Notice May 1, 2009. Accessed November 6, 2009.

26  American Geriatric Society.  Frequently Asked Questions (FAQ).  http://www.americangeriatrics.org/news/ags_faq.shtml. 2009. Accessed November 6, 2009.

27  Soeters PB, Schols AM. Advances in understanding and assessing malnutrition. Curr Opin Clin Nutr Metab Care 2009; 12(5):487–494.

28  Food and Drug Administration.  Medical foods, overview.  U.S. Department of Health and Human Services web site.  http://www.fda.gov/Food/FoodSafety/Product-SpecificInformation/MedicalFoods/default.htm. Updated May 18, 2009. Accessed November 10, 2009.

29  ADA Council on Practice Quality Management Committee. Identifying patients at risk: ADA’s definitions for nutrition screening and nutrition assessment [Erratum in: J Am Diet Assoc 1994; 94(10):1101.]. J Am Diet Assoc. 1994;94(8):838-839.

30  Department of Health and Human Services, Centers for Medicare & Medicaid Services. Medicare Program; revisions to payment policies and five-year review of and adjustments to other relative value units under the physician fee schedule calendar for year 2002. Federal Register. November 1, 2001;66: 55331.

31  Centers for Medicare & Medicaid Services. MDS 2.0 Public quality indicator and resident reports. Department of Health and Human Services web site. http://www.cms.hhs.gov/MDSPubQIandResRep/. Modified May 05, 2009. Accessed November 5, 2009.

32  Institute of Medicine.  Anthropometric risk criteria.  In:  WIC Nutrition Risk Criteria: A Scientific Assessment. National Academies Press. 1996:67-148. http://books.nap.edu/openbook.php?record_id=5071&pg67. Accessed November 10, 2009.

33  Centers for Disease Control. Use and interpretation of the CDC growth charts. http://www.cdc.gov/nccdphp/dnpa/growthcharts/resources/growthchart.pdf. Accessed November 6, 2009.

34  Blackburn GL, Bistrian BR, Maini BS, Schlamm HT, Smith MF. Nutritional and metabolic assessment of the hospitalized patient.  JPEN J Parenter Enteral Nutr. 1977;1(1):11-22.

35  White JV, Dwyer JT, Posner BM, Ham RJ, Lipschitz DA, Wellman NS.  Nutrition screening initiative: development and implementation of the public awareness checklist and screening tools.  J Am Diet Assoc. 1992;92(2):163-167.

36  World Health Organization. Global database on body mass index.   http://apps.who.int/bmi/index.jsp. Published 2006. Updated June 11, 2009. Accessed November 6, 2009.

37  Braunschweig CL, Levy P, Sheean PM, Wang X. Enteral compared with parenteral nutrition:  a meta-analysis. Am J Clin Nutr. 2001;74(4):534-542.

38  Osmolality and osmolarity (general information chapter 785). In: The United States Pharmacopeia, 30th rev., and The National Formulary, 25th ed. Rockville, MD: The United States Pharmacopeial Convention; 2007:334-51.

39  American Academy of Pediatrics, Council on Child Health. Age limits of pediatrics. Pediatrics. 1998;102:249-250.  Reaffirmed in: Pediatrics. 2006; 117:1846-7.

40  Lalonde RL. Pharmacodynamics. In: Evans WE, Schentag JJ, Jusko WJ, eds. Applied Pharmacokinetics: Principles of Therapeutic Drug Monitoring. Vancouver, WA: Applied Therapeutics; 1992:4-1–4-33.

41  Bauer LA. Clinical pharmacokinetics and pharmacodynamics. In: DiPero JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Physiologic Approach. 6th ed. New York: McGraw Hill; 2005:51-73.

42  The Joint Commission. Sentinel event policy and procedures.  http://www.jointcommission.org/SentinelEvents/PolicyandProcedures/. Revised July 2007. Accessed November 6, 2009.

43  National Institute of Standards and Technology. International System of Units (SI), rules and style conventions.  U.S. Department of Commerce Physics Laboratory. http://physics.nist.gov/cuu/Units/rules.html. Accessed November 6, 2009.

44  Institute for Safe Medication Practices. ISMP’s list of error-prone abbreviations, symbols, and dose designations.  http://www.ismp.org/Tools/errorproneabbreviations.pdf. Published 2007. Accessed November 6, 2009.

45  The Joint Commission. Official “Do Not Use” list. http://www.jointcommission.org/NR/rdonlyres/2329F8F5-6EC5-4E21-B932-54B2B7D53F00/0/dnu_list.pdf. Updated March 5, 2009. Accessed November 6, 2009.

46  International Committee of Medical Journal Editors (ICMJE). Uniform requirements for manuscripts submitted to biomedical journals: manuscript preparation and submission: preparing a manuscript for submission to a biomedical journal.http://www.icmje.org/urm_full.pdf. Accessed November 10, 2009.

47  National Institute of Standards and Technology.  The NIST reference on constants, units and uncertainty, International System of Units (SI), SI base units.  U.S. Department of Commerce Physics Laboratory. http://physics.nist.gov/cuu/Units/units.html /. Accessed November 6, 2009.

48  United States Pharmacopeial Convention. General notices and requirements. In: United States Pharmacopeial Convention, eds. The United States Pharmacopeia (USP 32), The National Formulary (NF 27). Rockville, MD: United States Pharmacopeial Convention, Inc.; 2009.

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