Non Per Os…Latin for…does my patient understand our fasting orders?

Non Per Os…Latin for…does my patient understand our fasting orders?

 

Author:  Leslie Mattson

How many different interpretations of NPO have we heard from our patients?   Some of my favorites are:

“I was hungry so I stopped for a sandwich”~

“I just drank a bottle of Gatorade, it is clear”

“Can have a tissue to put my gum in?”

“No one told me that I couldn’t smoke”

Regardless of whether it is the anesthesiologist or the surgeon, it is the care provider who is responsible for the patient’s airway.  No better time than the present to take a look at your facility’s NPO guidelines.   Some policies require that everyone is NPO after midnight while others allow clear liquids up to 6 hours prior the procedure. Maybe yours fall somewhere in between.

In light of the recent high-profile celebrity who arrested in an outpatient setting during a procedure and later passed, we all know that an increased focus on procedure risks will ensue, including the impact of eating and/or drinking prior to procedure.

So, here are some thoughts on NPO status you may want to consider:

  • How do you communicate your NPO requirements?  Do you put it in writing?
  • Do you request your patients acknowledge your requirement?  You may want to include it as part of your consent process.
  • Are the physician’s orders clearly defined, written, and signed off by the pre-operative nurse?  These could be a standing order, reflected in your pre-operative nursing documentation.
  • Is direction provided on gum chewing and smoking?  Check with your ordering physician to get specific guidelines for patient instruction.
  • What about diabetic patients? Do your orders direct medication changes and blood sugar testing?  You may want to include insulin pump settings as applicable.
  • If you instruct patients on clear liquids, how are they defined? (I reviewed a recent article that described clear liquids as “newsprint could be read through them, and no pulp was present”.  )
  • You may want to provide a generic risk statement related to non-adherence.  Patients may not understand pulmonary aspiration or aspiration pneumonitis, but they may be more compliant if they understand the why of the rules.

Click here for the current guidelines regarding NPO status from American Society of Anesthesiologists