The other day as I struggled to stay awake to watch the overly hyped Tyson-Paul boxing match, I recalled a quote from Tyson while musing about an annoyed patient earlier at work :
“Social media made y’all way too comfortable with disrespecting people and not getting punched in the face for it” – Mike Tyson
The distance & the anonymity of a screen makes being rude easy. In a similar vein, typing in orders on EMRs behind a screen makes it too easy to avoid your patient’s questions & displeasure, leaving the bedside nurses to deal with it – especially when it comes to the ‘NPO’ order!
It’s not uncommon to see the “NPO after midnight” order extend for hours next day as surgery gets delayed to late afternoon, while the NPO order continues. Meanwhile the patient’s hunger, thirst & displeasure builds. Besides ‘hangry‘, there are real clinical effects of prolonged NPO status. Post-op delirium, electrolyte issues, headaches, weakness, etc are worse with prolonged NPO . Fasting guidelines from the ASA have consistently stated that it’s ok to drink clear liquids up to 2 hours pre-op (water/juices/coffee) etc. yet isn’t universally followed. In this day & age of patient satisfaction scores, hospitals must look into this NPO business more closely & institute better NPO policies.
An NPO isn’t just an order, it should be considered an intervention with real consequences. Eating what & when we want is a basic need, pleasure & freedom – taking that away inappropriately without a buy-in from the patient is a literal ‘gut punch’. IMO, an NPO order on the EMR should force three things:
1. A check-box that says “Discussed with the patient”
2. A reason for NPO such as ‘procedure’, ‘ileus’, etc. so everyone knows why.
3. Auto-expiry in 8 hours, forcing a reconsideration if NPO is still needed after.
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