NPO: When It's OK To Take Meds vs. Not OK To Take Meds

Kitiger, RN · Sep 18, 2022

If the patient failed the swallow test, you need to contact the doctor to get the meds ordered by a different route.

HiddenAngels · Sep 18, 2022

13 hours ago, kelly parisi said:

I just started working at the hospital and I am so confused ?

I know if the patient failed a swallow test they can't take pills by mouth. We have had other NPO patients who the nurse will tell us "no pills by mouth" but then the nurse I'm orientating with will say: "no it's fine."

Def CANNOT take pills by mouth if they failed a swallow eval. When/If that patient chokes to death is that nurse who told you it’s okay for them to swallow pills gonna be in trouble or you?

Yes get the meds ordered by a different route like Kitiger said.

macawake, MSN · Sep 18, 2022

On 9/17/2022 at 9:53 PM, Kelly Kristen said:

I just started working at the hospital and I am so confused ?

I know if the patient failed a swallow test they can't take pills by mouth. We have had other NPO patients who the nurse will tell us "no pills by mouth" but then the nurse I'm orientating with will say: "no it's fine."

I get the feeling that you might be talking about two different categories of NPOs. One who has failed a swallow test and another category of patients who are NPO for another reason, for example before a procedure involving sedation or general anesthesia.

First of all, the nurse who said ”no, it’s fine” ought to have been able to explain why it was fine.

I’m not from the U.S. but I can’t imagine that what I’m about to say doesn’t apply universally..? Sometimes it’s okay to give medications per os with a small amount of water even when the patient is NPO. Obviously not to the patient who has failed a swallow test, but to patients who are NPO for other reasons. But a nurse has to be absolutely certain that this is the case in each individual instance. A physician/provider needs to have prescribed the medication and route knowing that the patient is currently NPO.

Please don’t take advice from anonymous posters on the internet on how to administer or not administer medications. You need to find out exactly what the guidelines are where you work and you need to know the specific circumstances for each of your patients. And if uncertain, always contact the patient’s provider.

Best wishes!

ladedah1, BSN, RN · Sep 18, 2022

On 9/17/2022 at 9:53 PM, Kelly Kristen said:

I just started working at the hospital and I am so confused ?

I know if the patient failed a swallow test they can't take pills by mouth. We have had other NPO patients who the nurse will tell us "no pills by mouth" but then the nurse I'm orientating with will say: "no it's fine."

Depends on the reason for the order.

If the patient failed their swallow, it is definitely not OK to provide oral meds. Sometimes I've seen newer doctors add exceptions for "sips with meds" on NPO orders for these types of patients (whether by mistake or because they didn't really think it through) and I will not hesitate to call them and question the order. If the patient is not safe to swallow, then they are not safe to swallow.

Now - if the patient is NPO for a procedure - that is often a different case, as these patients can often swallow fine and are only NPO temporarily for procedural safety. In this case, if an order for NPO does not have an any listed exceptions, then the doc would need to add an exception for "sips with meds" (or similar) to the NPO order before we give oral medications. Often, the orders for such patients will be written that way from the start; if not, clarification should be sought before giving oral meds.

Pepper The Cat, BSN, RN · Sep 19, 2022

Agreed with above. You need to differentiate between NPO because they failed the swallowing assessment and NPO for a procedure.