NPO and meds

[RN2B07]

Silly question, if pt. NPO do you hold all meds unless stated to give per MD? Are there exceptions, such as b/p meds? Thanks

[christvs, DNP, RN, NP]

Silly question, if pt. NPO do you hold all meds unless stated to give per MD? Are there exceptions, such as b/p meds? Thanks

I always get nervous about this too! I feel that if a pt. is NPO, then the docs need to spell out if this means hold all their meds or not. If it is not clear, I always call the doc and ask them if they want me to give the meds, and which ones. Usually (in a perfect world) they write for the meds to be given IV or other ways, but of course this doesn't always happen. But bottom line, if you are not sure, just call the docs up. :)

-Christine

[Tweety, BSN, RN]

You need clarification from the MD.

However, I've been known to give BP meds if they need it. Depending on the reason they are NPO. If they are NPO for a bowel obstruction I won't, I'll call the doc for IV meds. If they are NPO for surgery, I might call anesthesia and ask to give the meds. There have been times, especially when working night shift I just used my good old common sense. :)

[suebird3]

Where I work, we hold all meds except as specified by the MD. BP meds usually given (with sip of water). But if on insulin......that is definately held, especially if NPO.

Suebird

[rnmi2004]

Have you checked your hospital's manual? I was pleasantly surprised to see that in the pages & pages of my facility's P&P manual they have a section to address this. I've been spreading the word to my fellow nurses & even the ones who worked there for years didn't know it was there.

[GooeyRN, ADN, BSN, CNA, LPN, RN]

I always get nervous about this too! I feel that if a pt. is NPO, then the docs need to spell out if this means hold all their meds or not. If it is not clear, I always call the doc and ask them if they want me to give the meds, and which ones. Usually (in a perfect world) they write for the meds to be given IV or other ways, but of course this doesn't always happen. But bottom line, if you are not sure, just call the docs up. :)

-Christine

I agree with you. If they don't write if they want the meds held or not, they get a wake up call. (I am a nightshifter)

[ljds]

I agree with you. If they don't write if they want the meds held or not, they get a wake up call. (I am a nightshifter)

Same here.

However, most of our orders for our frequently performed procedures are now standardized; there is a place where the physician has to specify either "NPO including meds", "NPO except for meds", or "other". I tell you what, I am loving these standardized order sheets. It really makes the lazy/slacker physicians sit up and take care of their freaking patients. It has greatly reduced our phone calls for clarification.

[Beary-nice]

I always understood NPO to be NPO that included meds unless ordered otherwise by the MD. There are some tests, procedures etc that we do have orders to give certain meds with a sip of water like for heart caths, the cardiologist wants the pt to have their heart meds prior to the procedure. You hardly asked a silly question, do not worry about that!

[melinated]

it all depends...BP meds are tricky. if i cant get a doc on the phone, i may give the BP ones and hold the colace. if the pt is npo and on insulin some endocrinologists may start the pt on D5 or something and make you continue the insulin coverage. anesthesia can let u know also if pt headed for the OR....

good question. not silly.no question is dumb. we (nurses) learn every day.

[dayshiftnurse]

suebird, at one of the hospitals i agency with, one of the other nurses was really upset that i even called the doc to ask for clarification regarding insulin administration (in this case sliding scale)--she felt at that facility it is always given or else it would throw their blood sugars off. in fact when i called the doc, he did want it held. this patient was post dialysis w/ low BP and somnolent; morphine given earlier s/c for pain

when i called doc, he requested that the insulin be held since pt was not eating

[meownsmile, BSN, RN]

Sliding scale insulin is given to treat a known increase in sugar. It isnt ment to treat what the patient may be on the next draw. Even though the patient is NPO if the blood sugar is high it may still warrent the 2 units or so they might get. Scheduled insulin is a different picture.

If there is a NPO order at my facility ALL meds are held unless otherwise written to give with sips. Depending on the blood pressure they are held also unless the reading is on a high trend and then we call the doctor for an order with a sip of water depending on why they are NPO. Making the decision to call or not call is just prudent nursing judgement and noone should give you grief for making a decision to call or not call. If NPO for surgery the doctor usually refers us to the anestesiologist who makes the decision about meds.