Patients who fib about being NPO...

  1. This morning, I had a patient who said she had not had anything to eat or drink since 10pm last night(8/30). I asked her as well as the nurse in outpatient, and she told the anesthesia doc the same thing. We bring her to the room, and she proceeds to tell the CRNA, that she only had "less than 6oz of water at 5:30am" She didn't think water counted, despite being told not to have ANYTHING after midnight. She was having a breast augmentation under general anesthesia, so the poop hit the fan. I didn't get blamed because I had asked her but as it was, I was a little agitated because I am new to that specialty and it was the first endoscopic breast augmentation I had seen. She had a little attitude to begin with and something told me that she'd be the type to sue if she got aspiration pneumonia even though she was noncompliant. Long story short, I documented like crazy and wrote a small novel in the nurses notes detailing the conversation I had with her in pre-op and the fact that anesthesia as well as the surgeon were aware of the water at 5:30am. Sheesh, some of these patients make you want to scream! If I had been the surgeon or the anesthesiologist, I would have canceled her, but that's not my call. Thank you for letting me vent!!
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  2. 7 Comments

  3. by   NurseRoRo
    I've been there...the patient tells me she's had nothing to eat since midnight...then tells anesthesia (with me in the room) she had M&Ms at 4am because she was famished and didn't think they'd count against her. She also told me that she didn't have anything loose in her mouth like dental work. But she told anesthesia (again, with me in the room) "be careful with my crown. it's been known to just come off."

    We cancelled her. She had a hissy, "over a handful of M&Ms???"
  4. by   Marie_LPN, RN
    I don't know how many times a pt. says they don't have any body jewelry in "right now", yet, there's their tongue ring (a disaster waiting to happen), belly ring, and uh other rings and posts.

    We had one of those today, the icing on the cake was that even though they knew they were NPO, they thought breakfast (oatmeal, coffee, toast, scrambled eggs, bacon) didn't count.
  5. by   charebec65
    My 19 y/o son had surgery last week. He and I went over more than once that he could not eat or drink anything after midnight. I also went through the why...the possible ramifications. He swore to me he'd had nothing to eat or drink since midnight. He told his nurse the same thing. They take us upstairs and he tells the anesthesiologist that he'd had about "this much" (used his fingers to describe how much in a cup....would have been maybe 30-40ml) about 7am. Surgery wasn't til 2 so they went ahead with it with no complications. Well, on the way home he informs he that he'd actually had a big cup of water (probably 360 ml) right before we left for the hospital...... What an idiot.....
  6. by   mcmike55
    Every once in a while, I've run across one that thinks they know more about the risks of violating the NPO order than us!
    After a while, you sort of get a little ESP about it. You can almost tell at times they are lying!!! First it's "nothing", then it's a "sip", and before you know it, it's a farm hands breakfast!!
    Kids are tough, because they don't understand. We had a mom call in,,,enroute to the hospital for a T&A. She looks in the rear view mirror, and sees Jr, slugging down a Dew, that had been hid under the seat!
    See you another day kid!
    Probably the one that scares me the most was the returning pt, who had been canceled before for eating. On the way out of Ambulatory, after his procedure, a knee scope I think, he was overheard telling his family, "see I told you that NPO thing was crap!"
    He had eaten, and told us no.
    I stopped him, and told him to stop at the closest 7-11, and buy some lotto tickets.....because he was one lucky chump!!!!!
    I then reinterated to him the other route his little trick could have led him to!!
    Needless to say, we remember him. He comes back, we'll be much more cautious.
    Mike
  7. by   canoehead
    I had someone call the ER a few months ago desperate to allow her husband his morning coffee in spite of an NPO order. She was certain he's pee it right out before the surgery, so it wouldn't count, would it?
  8. by   Spidey's mom
    Those caffeine withdrawal headaches can be killer . . . .:uhoh21:

    We've given patients their pills in the a.m. with a sip of H2O with the doc's permission prior to surgery. I'm not sure that a sip or two of H2O is enough to cancel a surgery.

    A whole breakfast though - wow. I've never caught anyone in a lie . . . but we don't do a whole lot of surgeries.

    I do know that people hate being NPO - prior to blood tests, surgery, etc. And I don't get it - I rarely eat breakfast and it doesn't bother me at all.

    Regarding the lying - that happens in ER too . . .I'll ask a patient about allergies ("no allergies") or the history of what brings them in and then the doc comes in and they tell another story, which includes allergies. I hate that - fortunately our docs know patients don't always tell the whole truth.

    steph
  9. by   Marie_LPN, RN
    We've given patients their pills in the a.m. with a sip of H2O with the doc's permission prior to surgery. I'm not sure that a sip or two of H2O is enough to cancel a surgery.
    We sometimes have pts. who are told to take their usual morning meds. The surgeon usually specifies this in an order.

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