aspiration and NPO status

[NC29mom, ASN, LPN, RN]

Just wondering, is it a common practice for NPO orders to be written when a dementia patient aspirates? (Example: pt likely aspirates during meal, order written for NPO status x 48°, then normal feedings continue)

In my opinion, this is expected dz progression. Eating/ drinking at the end of life can be a comfort measure. I don't see how making a pt NPO for 24-48° after incident solves anything.... now if the family requests it that's one thing. ...

[TammyG]

We never write NPO orders, even with aspiration risk. Of course we caution against feeding when a patient becomes unable to swallow at EOL. But if the patient wants to eat, even with aspiration risk, we let them. Instead, we give the family instructions on aspiration precautions (sitting upright, feeding small amounts, ensuring swallowing before giving additional food, that kind of thing).

[toomuchbaloney]

Most hospice professional POCs reflect the family choice in this matter. NPO is rarely a good option for the patient who desires to eat or drink, regardless of aspiration risk.

It is true that eating and drinking are viewed comfort measures at end of life so withholding them may seem cruel to the family and patient.

Use of thickeners in the liquids may help with that choking.

It is important to engage the family or caregivers in a good deal of communication and education when this is an issue. Knowledge will go a long way in helping them to cope and to find peace in those last days.

Good luck.