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, writing NPO after midnight with the exception of clear liquids.
Responses on Facebook, however, showed a stricter adherence to the traditional no eating or drinking after midnight before surgery; it was fairly unanimous that institutions still follow this ancient practice (though one person did ask, “What’s npo?”!).
Well, it’s clear that this month’s CE article by Jeannette Crenshaw is sorely needed. “Preoperative Fasting: Will the Evidence Ever Be Put into Practice?” addresses the fact that despite 25 years of evidence and standards showing that NPO after midnight is not good practice, it is still used in most hospitals and preoperative practices. The evidence support clear liquids up to a few hours before surgery, and many groups have endorsed carbohydrate-rich beverages along with clear liquids up to a few hours before surgery.
So read Crenshaw’s article and disseminate it to your colleagues and clinical practice committees—practice changes should be based on evidence, and for this, the evidence is clear.