Question re: NPO and meds

Tweety, BSN, RN · Mar 8, 2007

Usually NPO means NPO, unless and MD order specifically says "NPO except for meds". If they are important meds to the patient and they are not NPO for obstructive problems (or if they are having obstructive problems I call for an IV alternative), I call the MD for clarification. For pre-op patients, I've talked to anesthesia enough times to know to give their important meds, or pain pills with sips, and document that on the pre-op checklist.

But the official policy is NPO means NPO including meds. But the nurse has to use some common sense and critical thinking "If I hold this Cardizem because the patient is NPO, what are the consequences going to be? What are their current vitals, etc." and not just blindly hold meds for NPO.

DolphinRN84, MSN, RN, APRN, NP · Mar 9, 2007

Hmmm, thats a very interesting post Tweety. Thanks for the info :) Though at my facility, when I oriented, I was taught that when a patient was NPO, you'd give the Cardiac or BP meds..and hold everything else like vitamins, meds needed to be taken with food, etc. But that is an interesting point. That seems common sense though to just give the MOST important drugs. I don't know, IMO.

nursequeenie · Mar 10, 2007

My favorite is the Dr. writes NPO, then orders ORAL CONTRAST!!!:monkeydance:

Tweety, BSN, RN · Mar 10, 2007

Lena, basically that's what we're taught. But unless there's an official policy written to give cardiac meds, you're really not covered when a doctor writes NPO, you need clarification and a doctors order "o.k. to give cardiac meds when NPO". But we really don't do it, we just use common sense and give them.

km5v6r, EdD, RN · Mar 10, 2007

I work in a transplant facility. The cardinal rule around here is NEVER hold the transplant meds. They have to be given as ordered at the times they are ordered no matter what. There is no safe IV alternative for FK506.

Common sense should be the rule with other meds. If it is a once daily med like Dig or Synthroid then it usually can wait until after the procedure. If it is a oral hypoglycemic they shouldn't take it while not eating any way. Keep in mind to that the hospital orders an arbitary schedule for meds any way. For example at my hospital all the transplant meds are ordered for 0800 for consistancy in testing drug levels. All of the other meds start at 0900. This is the schedule set by pharmacy not the docs. At home a majority of the pts batch thier morning meds together at one time. Depending on how busy my day looks I will too.

DolphinRN84, MSN, RN, APRN, NP · Mar 10, 2007

Lena, basically that's what we're taught. But unless there's an official policy written to give cardiac meds, you're really not covered when a doctor writes NPO, you need clarification and a doctors order "o.k. to give cardiac meds when NPO". But we really don't do it, we just use common sense and give them.

Thanks for the post again Tweety. Actually now I've been seeing at my hospital when doctors put it in orders for an NPO diet before a procedure, I have noticed that some do put "NPO except meds and ice chips." Makes it easier! But commom sense does go a long way.

morte, LPN, LVN · Mar 10, 2007

CYA, CYA, CYA,.....if it says NPO they aint gettin nottin from me.....that said, i will haunt the physician for clarification... "you dont want them getting their BP meds with a BP of 210? or as was pointed out about transplant meds.....

Pediatric Critical Care Columnist · Mar 11, 2007

There is no safe IV alternative for FK506.

Actually, FK506 is available as an intravenous formulation. The usual dose is 0.05 - 0.1 mg/kg/day as a continuous infusion. It's not the desired route, but many of our transplant patients are initially too sick for enteral meds for the first several days. We often run tacrolimus infusions, and give the mycophenolate and steroids as intermittent IV doses as well. Having said that, I agree that if the patient is NPO for a test or a surgical procedure that ins't likely to require ICU care post-op, then they need to be given their oral immunosuppressants with a sip of water and have that fact documented on their pre-op checklist. My son is a liver recipient (18 years and counting!) who requires a general anaesthetic for dental work, and I always give him his cyclosporine and his megadose of amoxicillin before we leave for the dental center. The rest of his meds wait until afterwards when he's awake again.

cardiac.cure03 · Mar 12, 2007

And also... Why are they NPO...For what procedure? If they're going for an EGD (like my pt last week), Ahhhh yeah... Makes sense why I wanna hold all meds possible :barf02: