Hospital Pharmacy - December 2020 - 374

Hospital Pharmacy 55(6)

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participants were invited based on the corresponding
author's perception of their active involvement in the
field as supported by their educational, research, or professional committee involvement in pharmacy nutrition
support, particularly in the American Society for
Parenteral and Enteral Nutrition (ASPEN). Seven
author participants are board certified in pharmacy
nutrition support, whereas 1 author is certified in an
area whereby nutrition support is part of her practice
(eg, critical care). Some authors have multiple board
certifications including critical care, pharmacotherapy,
and pediatrics. The duration of individual practice experience of the authors ranges from 5 years to more than
30 years posttraining. Members of this authorship group
have advanced practice roles with direct patient care
responsibilities for prescribing parenteral nutrition
(PN) and/or enteral nutrition (EN), laboratory analysis,
and pharmacotherapy integrated with nutrition therapy
(eg, fluid and electrolytes, vitamins, trace elements, prokinetic drugs, insulin, antidiarrheal, and laxative therapy), and some have administrative or supervisory roles
with respect to nutrition support therapies. This authorship group has a broad range of practice experiences.
Most authors are acute care-based, but some have
long-term care (home PN and EN) responsibilities.
Current practices of the group range from pediatrics to
geriatrics. Some members have a diverse patient population, whereas others practice within a focused patient
population (eg, pediatrics, oncology, trauma).
The author participants were asked by the corresponding author to identify articles published from
January 2019 to December 2019 that resulted in a
change or affirmation of their current clinical practice
or that they considered to be important for future clinical practice. Some authors collated papers read from
their personal journal subscriptions, organizational
membership newsletters, or institutional-based journal
clubs. Others included those articles retrieved from an
online search strategy. This methodology for collection
of articles has the limitation that the process for identifying significant articles lacked a consistent structured
literature search strategy. As a result, it is possible that
omission of pertinent articles applicable to pharmacy
nutrition support practice that were published in less
common journals and not routinely read by the author
participants were not identified.
Only those articles available in print format were
allowed for potential inclusion. Articles available only
in preprint electronic format (with intention of publication by the journal in 2020 or later) were not evaluated.
The citation list was compiled into a spreadsheet whereby the author participants were asked to denote whether
the paper was considered important to pharmacy nutrition support practice. An abstract and complete citation
of each paper was provided along with the electronic

spreadsheet to assist the author participants with the
evaluation process. To ensure an independent voting
process without influence from the other participant
members, only the corresponding author was aware of
others' rankings. To prevent influence from the other
authors on the corresponding author, dichotomous
grading of all the papers as important or not by the
corresponding author was completed prior to review of
the results from the other contributors. The votes were
tallied. The article was considered important if at least 5
out of 8 participants voted for a paper to be of high
priority in its relevance to pharmacy nutrition support
practice. In the event an insufficient number of new scientific papers were culled from the initial voting process,
a secondary run off from those papers whereby a split
decision (whereby 4 out of 8 authors designated the article as important) was performed in an effort to improve
the yield of papers. From this system, a culled list of the
most important articles was created. The sorting process
for the articles is depicted by Figure 1.

Results
A total of 111 articles were collectively collated for initial
evaluation by the authorship group. An average of 22
papers (range: 13-36) were denoted as significant by individual members of the author group. Since only 4 papers
from the primary literature were collectively identified as
most important by the majority, a second consensus vote
was taken among 11 papers whereby a split decision (4
out of 8) occurred. The authors were instructed to vote
for no more than 5 or 6 papers in this second runner-up
evaluation. An additional 2 papers were voted as important by a majority of the authors which allowed for
a total of 6 papers to be identified for further
evaluation.7-12 An additional 9 articles comprising organizational guidelines, consensus, recommendation, and
position papers included separately as important
papers to our practice.13-21
Of these 15 finalist articles, 6 were published in
Journal of Parenteral and Enteral Nutrition, 6 in
Clinical Nutrition, 2 in Journal of Trauma and Acute
Care Surgery, and 1 in Nutrition in Clinical Practice.
Individual rankings, based on relevancy to pharmacy
nutrition support clinical practice according to the
author participant group, are given in Table 1.
The finalist publications from the primary literature
are summarized in the discussion along with a narrative
regarding their implications for pharmacy nutrition support practice. A list of guidelines, position, recommendation, and consensus papers from organizational
societies are provided in Table 2. The remaining 96 citations from the primary literature that did not make the
finalist papers are provided in an online supplement.

Hospital Pharmacy - December 2020

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