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Preoperative Evaluation/Patient Issues/How do you convince surgeons to follow guidelines on NPO status?

QUESTION:

"How do you convince surgeons to follow the ASA guidelines on NPO status? Some of our surgeons want ALL patients NPO after midnight, including infants and children, some of whom are not done until late morning or in the afternoon. Do most institutions follow the guidelines?"

-- From Linda Logan, CRNA

REPLY

"I believe that most institutions follow the ASA guidelines, or have minor modifications to suit individual situations. My guess is that your surgeon is not ignorant of the evidence behind the change in NPO times. Most likely he or she has suffered a few cancellations from some anesthesiologists for "NPO violations" and does not want to take a chance again.

What you may want to try is to promise that patients will not be canceled or delayed for NPO violations. To ensure safety, you'll need to make sure that the nurses who make preoperative phone calls give patients proper instructions. You may want the parents to know of the new guidelines and thank the surgeons for not starving their kids and stress the fact that the kids were happier coming in for surgery.

If all else fails, you may want to make this a QA initiative by looking at the fasting times for all surgeons, and make this one stand out as the odd one. Peer pressure often works."

-- From Raafat S. Hannallah, MD,  Washington, DC

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