Southern Hospitality: How We Changed the NPO Practice in the Emergency Department

Denton, Traci D.

doi:10.1016/j.jen.2014.12.001

Cited by 8 publications

(9 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is the first systematic literature review that aimed to identify and evaluate current interventions seeking to reduce preoperative fasting times for acutely ill hospital patients, summarizing effective interventional strategies and associated outcomes. Findings from this systematic review indicate that reducing the preoperative fasting period does not increase the risk of aspiration upon induction of anaesthesia and, therefore, does not compromise patient safety, thus supporting current literature 1–4,7,8 . In addition, patients’ physical and psychological well‐being is significantly improved with a reduced fasting time.…”

Section: Discussionsupporting

confidence: 72%

“…[1][2][3][4] However, the American Society of Anaesthesiologists guidelines 5 state that solid food may be taken ≤6 hours prior to a procedure requiring anaesthesia and clear fluids (including but not limited to water, pulp-free juice, clear tea, black coffee, carbonated beverages, and clear, carbohydrate-rich drinks), 6,7 ≤2 hours prior to a procedure requiring anaesthesia. Despite these guidelines, numerous studies 4,7,8 report the enduring nature of such outdated customs, with fasting times reported to be frequently longer than the expected 6-8 hours and often as long as 10-16 hours. [9][10][11] Additionally, it is common for patients to be indefinitely placed on NBM orders, particularly when procedures are cancelled or rescheduled, for symptom management or for safety of healthcare provision.…”

Section: Introductionmentioning

confidence: 99%

“…18,19 However, ERAS does not specifically address the reduction of fasting during the preoperative period and the complex barriers to change involved. Although some studies report interventions aiming to reduce prolonged preoperative fasting in different settings, 7,8,21 the question arises as to whether interventions, which also take into consideration the barriers involved (as well as incorporate strategies to ensure successful implementation), have been trialled.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Interventions Aimed at Reducing Fasting Times in Acute Hospital Patients: A Systematic Literature Review

2020

View full text Add to dashboard Cite

Despite current guidelines recommending fasting from solids for ≤6 hours and clear fluids for ≤2 hours prior to surgery, outdated practices endure; patients fast for unnecessarily prolonged periods because of beliefs regarding aspiration risk upon anaesthesia induction. This literature review aimed to identify and evaluate current interventions aiming to reduce preoperative fasting times for acutely ill hospital patients, summarizing effective interventional strategies and associated outcomes. EMBASE, MEDLINE, PreMEDLINE, and CINAHL were systematically searched. Quality of evidence was assessed using Cochrane risk‐of‐bias tools. Studies, of any type, reporting fasting times as a primary or secondary outcome were included. A total of 1918 potential studies were identified; of these, 16 studies were included. Seven studies investigated the effect of changing fasting protocol on gastric fluid volume/residual gastric volume (GFV/RGV) and gastric pH as surrogate measures for aspiration risk. No significant differences in GFV/RGV and gastric pH due to reduced preoperative fasting were reported, thus no change in aspiration risk. Eight studies documented improvements in patient‐reported outcomes with shorter fasting times. However, this review identified a paucity of studies that trialled interventions to reduce fasting times as the primary aim. These interventions were multimodal and multidisciplinary in nature, incorporating principles of implementation science to successfully achieve significant reductions in fasting times. This review highlights that reducing the preoperative fasting period is safe while improving patient's physical and psychological well‐being. Further high‐quality studies that investigate multimodal interventions, and that utilize implementation science principles, are required in this area.

show abstract

Section: Discussionsupporting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Interventions Aimed at Reducing Fasting Times in Acute Hospital Patients: A Systematic Literature Review

2020

View full text Add to dashboard Cite

show abstract

“…First, many ED patients are kept nothing by mouth (NPO) for an anticipatory procedure. NPO status should be reassessed, and EPs should address hydration, avoid unnecessary NPO order, and consider feeding assistance [46][47][48]. Since the decreased activity level is associated with delirium [20], a mobility assessment and a trial of ambulation are a part of geriatric assessments [49].…”

Section: Treatmentioning

confidence: 99%

Succinct Approach to Delirium in the Emergency Department

Lee

Angel

Han

2021

Curr Emerg Hosp Med Rep

View full text Add to dashboard Cite

Purpose of Review This study aims to provide a concise delirium review for practicing emergency medicine providers using the Assess, Diagnose, Evaluate, Prevent, and Treat (ADEPT) framework. Recent Findings Delirium is a form of acute brain dysfunction that results in significant mortality and morbidity for older emergency department (ED) patients. Delirium is frequently missed by healthcare providers, but monitoring for this syndrome using brief delirium assessments may improve recognition. Once delirium is diagnosed, emergency medicine providers' primary goal is to perform a comprehensive history and physical examination to uncover the underlying etiology for delirium. This includes obtaining history from a collateral historian and obtaining an accurate medication history. If posssible, emergency physicians (EPs) should treat the medical etiology that precipitated the delirium. If agitated, non-pharmacologic interventions such that minimize the use of tethers are preferred. Pharmacologic agents such as antipsychotic medications should be used as a last resort. Summary Delirium is a common geriatric emergency and requires the EP to assess, diagnose, evaluate, prevent, and treat. Delirium is a key geriatric syndrome that geriatric ED providers should routinely screen for. A strong emphasis is on the widespread use of delirium screening, followed by prevention and treatment efforts.

show abstract

“…Fasting is the main strategy used to avoid perioperative pulmonary aspiration during elective procedures under general anesthesia [1][2][3][4], but previous studies focused on adults or children with non-serious diseases [5,6]. Whether a 2-h preoperative fast is an optimal strategy for children with cyanotic congenital heart disease (CCHD) requires further exploration.…”

Section: Introductionmentioning

confidence: 99%

Effect of Oral Glucose Water Administration 1 Hour Preoperatively in Children with Cyanotic Congenital Heart Disease: A Randomized Controlled Trial

et al. 2020

View full text Add to dashboard Cite

Background Guidelines recommend a clear liquid fasting time of 2 h before surgery, which is often exceeded, leading to adverse reactions (ARs) such as discomfort, thirst, and dehydration. We assessed the gastric contents and ARs after oral glucose water administration 1 h prior to surgery in children with cyanotic congenital heart disease (CCHD). Material/Methods This was a non-inferiority randomized controlled trial of children with CCHD enrolled at the Fujian Medical University Union Hospital from 09/2014 to 05/2017 and randomized to receive oral glucose water (10 g of glucose in 100 ml of warm water, 5 ml/kg) 2 h (2-h group, n=174) or 1 h (1-h group, n=170) before surgery. The primary endpoint was gastric volume. Secondary endpoints included pH of gastric content, preoperative blood glucose, and risk factors for aspiration pneumonia. Pre- and intraoperative ARs were recorded. Results The 1-h group showed smaller gastric content volumes (0.34±0.35 (95% CI: 0.29–0.39) vs. 0.43±0.33 (95% CI: 0.38–0.48) ml/kg, t =2.55, P <0.05) and higher blood glucose (6.21±0.78 (95% CI: 6.09–6.33) vs. 5.59±1.11 (95% CI: 5.43–5.76) mmol/L, t =−5.91, P <0.001). The 95% confidence interval of the volume difference between the 2 groups was 0.017–0.163, the upper limit value was 0.163 <δ=0.2 ( P <0.01). The non-inferiority hypothesis was correct. The 1-h group showed lower incidence of crying, thirst and hypoxia (all P <0.05 vs. 2-h group). There were no differences in ARs between the 2 groups. Conclusions A 1-h fast prior to surgery was not inferior to a 2-h fast in terms of gastric residuals and ARs in pediatric patients with CCHD. Clinical trial registration: http://www.chictr.org.cn/showprojen.aspx?proj=9563 Registration number: ChiCTR-IPR-14005270

show abstract

Southern Hospitality: How We Changed the NPO Practice in the Emergency Department

Cited by 8 publications

References 6 publications

Interventions Aimed at Reducing Fasting Times in Acute Hospital Patients: A Systematic Literature Review

Interventions Aimed at Reducing Fasting Times in Acute Hospital Patients: A Systematic Literature Review

Succinct Approach to Delirium in the Emergency Department

Effect of Oral Glucose Water Administration 1 Hour Preoperatively in Children with Cyanotic Congenital Heart Disease: A Randomized Controlled Trial

Contact Info

Product

Resources

About