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Second Opinions > Should NPO orders stand until consults a...

Should NPO orders stand until consults are completed?

I'm a new OR nurse manager in a small, rural, critical-access hospital. We seem to have a dilemma concerning patients awaiting surgical consults who aren't being held NPO. This causes delays, sometimes for 6 to 8 hours, in the resulting surgical procedures (not emergent ones) because patients have been fed. Those that fed the patients argue that they didn't want them to be hungry. However, the case delays mean overtime for employees who have to stay after hours to do the surgery.

Does anyone have suggestions or information I can present to educate and back up the importance of maintaining NPO until the surgical consult is done?

Started by: Sheryl Lefort (OR Manager/Supervisor) at February 20, 2013 (11:57 am)

Comments and Responses

View: earliest first

I agree with Kim S. Scheduled without a consult? Are we discussing emergent cases? Is there some question about why the patient was scheduled in the first place?
Maybe your institution should clarify the requirements for scheduling. This being an outpatient surgery discussion one could assume the surgeon had already been approached about the patient.

The ASA guidelines regarding npo are clear. 6 hours solid and 2 hours clear. anything else can only proceed if it is emergent (documented such by surgeon)and not just necessary to proceed so the surgeon can make his/her golf time. I agree patient comfort is important but this sounds more like a process problem.

Bruce Demko (Anesthesiologist/Nurse Anesthetist) at February 22, 2013 (11:53 pm)

I'm confused as to why patients are being scheduled for surgery if they need a consultation? This seems like a process problem. The facility could improve delays by arranging the majority of consults prior to the day of the procedure, thus deminishing the cancellations as well, improving patient satisfaciton, and improving surgical throughput.

Kim S. (Director, Surgical Services/Director of Nursing) at February 22, 2013 (9:43 am)

NPO is clear.No solids,no liquids because there is no diagnosis yet.Start a slow running iv if the patient is thirsty,administer a proton pump inhibitor with a sip of water and sodium citrate or Mg citrate 30 ml(as per obs.recommendations) and wait patiently for the surgeon to appear.In the meantime the patient might do a lot of things;physical examination by another phìysician or a RN,lab tests,watch TV or listen to radio....The problem of consultation delay could be approached by imnproving the general organization of the facility.CM;Md,Anesthesiologist.

Claudio melloni (Anesthesiologist/Nurse Anesthetist) at February 22, 2013 (6:52 am)

I've found that patients get more upset over a delay regardless of the cause than missing a meal. Npo means Npo. the surgery can proceed immediately after the consult is completed or the patient can eat if furthur fasting is not required. As mentioned even fasted patients can and do aspirate and everything must be done to minimize this risk.

Bonnie Bowman (Anesthesiologist/Nurse Anesthetist) at February 21, 2013 (3:55 pm)

Anesthesia rule of thumb is 8 hours NPO if the patient ate solids, or 6 hours NPO for liquids, some of this guideline are in the ASA recommendatons. The safety of the patient comes first. Aspiration can happen
M. Gutierrez R.N.
Moore County Hospital Surg. Dir.

Maria Gutierrez (Director, Surgical Services/Director of Nursing) at February 21, 2013 (3:43 pm)

I'm confused by this discussion: NPO is an ORDER given by a PA, NP or physician. That order should be given for a specific medical/surgical indication. NO PA,NP or physician order should be suspended without the ordering practitioners' or their coverages' approval.

C. Frederick (Anesthesiologist/Nurse Anesthetist) at February 21, 2013 (3:40 pm)

I agree with "Mean S." The decision to feed a patient waiting for a surgeon's consult can literally be a life and death decision. At the very least it can result in delayed surgery.... or a much more complex induction of anesthesia.... even with all the "full stomach" precautions, patients can regurgitate, aspirate, get pneumonia and rarely (fortunately) die from sepsis or respiratory failure.

If timely consults are a problem, hospital administration and Medical Staff should pressure surgeons for greater responsiveness to the consults.

Jim T. (Medical Director/Chief Surgeon) at February 21, 2013 (2:12 pm)

No, I think the patient's comfort should come just behind safety whenever possible.

Mean S. (Administrator/Director/Manager/Owner/Executive Officer) at February 21, 2013 (1:22 pm)

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