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.