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Is NPO really NPO??

Posted
LH366 LH366 (New) New Nurse

Specializes in ED. Has 3 years experience.

Hi guys, I have kind of a stupid question but I feel like I keep seeing different answers. I know NPO is nothing by mouth, but I feel like sometimes it is not followed like that. I see some people say it's okay to give ice chips and some not. For example, last night I had a patient that was npo except meds, but kept asking for water. I just double checked with the MD that patient needed to be NPO and the MD made it seem like I can give him some water here and there. If that's the case, then shouldn't that be specified? I gave him a very small amount of water around 12am but none after that in case he had a procedure in the AM. What are your cases with NPO? I'm just worried I gave this patient some water when I shouldn't have. For reference, I work in the ER, so I usually send my patients up before they complain about being NPO LOL.

Ideally they should write/enter the orders the way they want.

NPO

NPO /x ice chips

NPO /x meds /c sip water

In the ED there are lots of order sets utilized for convenience and NPO (without additional specifics) is usually what is included.

If the provider wants the patient to be able to have something by mouth, obtain a verbal order or have them change the order.

48 minutes ago, JKL33 said:

Ideally they should write/enter the orders the way they want.

NPO

NPO /x ice chips

NPO /x meds /c sip water

In the ED there are lots of order sets utilized for convenience and NPO (without additional specifics) is usually what is included.

If the provider wants the patient to be able to have something by mouth, obtain a verbal order or have them change the order.

This is my understanding and how I have seen it play out. If the doctor wants sips or ice chips, best to clarify it with an order, just in case.

pr0dr0me, BSN, RN

Has 3 years experience.

Our orders say "NPO including meds," in which case meds must be via another route, "NPO except meds," in which case a small sip of water is allowed only to take pills, and sometimes an additional order listed under Nursing Orders or Nutrition Orders that states "Patient may have ice chips" or whatever else. So, if it says just NPO, then I ask the doctor if they can have an order for ice chips and they say yes, I can put that in as Verbal with Readback. Sometimes they're really specific, like NPO including meds except that their morning beta blocker should be given before their CABG.

nrsang97, BSN, RN

Specializes in Neuro ICU and Med Surg. Has 20 years experience.

Our orders usually say NPO except ice chips, or NPO with sips of water for medications. Other than that just NPO. We can give mouth swabs, but not any water to drink.

8 hours ago, JKL33 said:

Ideally they should write/enter the orders the way they want.

NPO

NPO /x ice chips

NPO /x meds /c sip water

In the ED there are lots of order sets utilized for convenience and NPO (without additional specifics) is usually what is included.

If the provider wants the patient to be able to have something by mouth, obtain a verbal order or have them change the order.

Obtain a WRITTEN order.

13 minutes ago, Elaine M said:

Obtain a WRITTEN order.

Whether they put it in themselves or I follow through on a proper verbal order (which also gets put into the system), it is "written." All proper verbal orders end up "written," if it doesn't then it wasn't a proper verbal order. Which I would not and did not suggest.

Edited by JKL33

LibraNurse27, BSN, RN

Specializes in Community Health, Med/Surg, ICU Stepdown. Has 8 years experience.

stupid question... why are ice chips OK but not water? isn't ice... water? always wanted to ask that but feel like it's a dumb question

pr0dr0me, BSN, RN

Has 3 years experience.

31 minutes ago, LibraNurse27 said:

stupid question... why are ice chips OK but not water? isn't ice... water? always wanted to ask that but feel like it's a dumb question

It does turn into water, yeah, but for a patient who isn't a high aspiration risk and just needs to keep their stomach empty for decompression or before surgery, the tiny amount of water that they get very slowly from having a couple of ice chips every couple of hours is small enough not to matter.

Been there,done that, ASN, RN

Has 33 years experience.

There are many variations to NPO.

"The MD made it seem like I can give him some water here and there. If that's the case, then shouldn't that be specified?" Yes it should. You needed to clarify the order with the physician.

JadedCPN, BSN, RN

Specializes in Pediatrics, Pediatric Float, PICU, NICU. Has 15 years experience.

Agree with above comments. In general, if the med specifies "NPO except meds," they can have sips of water ONLY with their meds. Most of us wouldn't be able to swallow pills without having a sip of water, so this is kind of implied.

K+MgSO4, BSN

Specializes in Surgical, quality,management. Has 12 years experience.

I actually wrote our hospitals fasting for surgery procedure.

In normal GI tract water leaves the stomach in 2-4 hrs (ANZCA) therefore moderate clear PO fluids can be taken until 4hrs prior to surgery. It also reduces the secretion of excess gastric contents (GESA) thus reducing stress on the body and further discomfort or aspiration risk.

Most meds should be given prior to surgery with specific review of anti coagulation agents and those at risk of interacting with anaesthetic agents.

However, if you patient has a bowel obstruction do not give PO meds or crush them up and put them in the tube meant for drainage. They will not be absorbed until the peristaltic action of the bowel returns and then they may have multiple doses of medicine in their stomach.

Ice or sips are same risk. Other options to refresh the mouth should be offered such as brushing teeth, mouthwash or products that assist eith dry mouth including providing lip balm.

Numenor, BSN, MSN, NP

Specializes in Internal Medicine. Has 9 years experience.

NP here. Generally we are okay with sips of water/ice chips but it should be specified. Rarely is there an ABSOLUTE NPO order but it happens in certain situations.

Usually we get the "NPO, no exceptions, no meds" order when a patient is an aspiration risk and we're waiting for speech to clear him/her or patient is an established risk (I.e. PEG tube feedings, etc.). SBO patients are obviously no exceptions, especially when they have an NG tube to suction.

We'll usually see "NPO except meds with sips of water" when a patient is NPO for a procedure or a diagnosis for something other than SBO. For example, pancreatitis patients can usually get their meds, even though we're not feeding them.