Killing Traditional Nursing Duties #3 – NPO after Midnight

fasting Buddha/ via Wikipedia Commons

By Shawn Kennedy, editor-in-chief

In early August, on our Facebook page, we asked if there were “old nursing habits” that should be killed off. We received a lot of feedback, which we described in a blog post called “Killing Traditional Nursing Duties #1.” We did another post on the answers to our second question, “When you give IM injections, what site do you most often use—dorsogluteal (upper outer quadrant of buttocks), ventrogluteal (lateral hip), or deltoid (upper arm)?” This also got many comments in response.

Our last question was this: “Does your institution routinely follow ‘NPO after midnight’ for preoperative patients?” Here’s some of the comments we received on the blog:

My institution does follow the NPO after midnight for preop patients. I sometimes disagree d/t the time patients may be going to surgery. If a patient is not scheduled for the OR until the following day at 5 pm, why should they have to be NPO after midnight the night before?

…most of the younger anesthesiologists/CRNA’s allowed BLACK COFFEE to be drunk right up until time  of surgery. No dairy or sugar in it, obviously.

The facility that I work for does routinely follow ‘nothing by mouth’ after midnight guidelines. If the patient  is scheduled for a late surgery I may call the doctor and request that the orders be altered and in most cases the doctor’s are agreeable and will change the orders, […]

2016-11-21T13:11:47-05:00October 11th, 2011|nursing perspective, nursing research|0 Comments
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Killing Traditional Nursing Duties #2

This 2006 image depicted an adolescent female ...

Editor’s note: In early August, on our Facebook page, we asked if there were “old nursing habits” that should be killed off. We received a lot of feedback, which we described in a blog post, “Killing Traditional Nursing Duties #1.” We’re back now with feedback from our second question: “When you give IM injections, what site do you most often use—dorsogluteal (upper outer quadrant of
buttocks), ventrogluteal (lateral hip), or deltoid (upper arm)? Why?”

Hands down, the deltoid injection site was preferred for intramuscular (IM) injections, especially for immunizations and if the patient was an adult. (“People don’t have to drop their drawers” was my favorite reason cited.) A few of those who favored that site noted that, if they didn’t use the deltoid (because of the volume of the injection), they would then go to the ventrogluteal site. One person preferred the vastas lateralis (the outer middle third of the thigh), which wasn’t listed as a choice, but is certainly a site that’s used, especially in infants. And several respondents said they prefer the dorsogluteal site. Reasons given were “more comfort” and “more muscle.”

This is actually contrary to current evidence and teaching, which is that the preferred site is the ventrogluteal site. As noted in an article we did in February 2010, evidence indicates we should avoid the dorsogluteal site because “it poses unnecessary and unacceptable risks of […]

2016-11-21T13:11:59-05:00September 6th, 2011|nursing perspective, nursing research|3 Comments
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Killing Traditional Nursing Duties #1

By Shawn Kennedy, MA, RN, AJN editor-in-chief

We recently had a lot of feedback to a question we posted on our Facebook page: “We know old habits die hard and nursing has a lot of them. What old habits do you think we should kill? NPO after midnight? Routine temps on every patient?”

We got several good responses:

– Waking patients up at 4am for blood drawing, routine vital signs

– Measuring intake and output on every patient

– Taking routine temps

– Giving dorsogluteal IM injections

– Doing a skin prep for an IV by swabbing the site in a circular motion, inside to out (some manufacturers of products are instructing that skin prep be done by a scrubbing motion)

– Enemas before childbirth

– Double documenting

– Rushing to give medications right on time (which makes one prone to error)

– NPO after midnight

Choosing from the above, we then asked this: “Survey question #1: Do you routinely wake patients up at night to check their vital signs? If not, when would you?”

This question received many comments, from “Of course not” and “only when necessary” to “If a doc orders q 4 vs and you don’t do it and something happens to the patient, that would not be good for you AT ALL.” Also this: “Orders are orders which we must follow.”

Commenters cited several stories of recent postoperative patients (who, I agree, should have vital signs frequently monitored) who could have suffered grave consequences had the nurse not woken them […]

2016-11-21T13:12:04-05:00August 24th, 2011|healthcare social media, nursing perspective|6 Comments
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