instructions, but also pictures of the products they're going to be tak-
ing."
She says some facilities have developed patient diaries or checklist
pages — and some have even set up HIPPA-compliant smartphone
apps that provide patients with alerts about what to eat and when,
along with the ability to digitally communicate with their providers.
There's another half of the equation, too: making sure relevant staff
are experts on pre-op nutrition and enhanced recovery. "Whoever's talk-
ing to the patient really needs to understand why you are doing it and
what the benefits of it are," says Ms. Chappell.
"You can do so much when the patient is informed from the sur-
geon's office," adds Lynn Reede, DNP, MBA, CRNA, FNAP, senior con-
sultant for education and practice at the American Association of
Nurse Anesthetists. "Work with the staff in those offices to help them
understand how to talk with patients in a way that gives them confi-
dence that they will be part of the decision-making and their care.
Making it work
Much of enhancing pre-op nutrition involves foods patients can buy at
a grocery store — high quality proteins, fish, whole grains, and fruits
and vegetables — but there's a growing movement to do away with
traditional pre-op fasting requirements, which have been standard in
surgery for decades. In fact, Enhanced Recovery After Surgery
(ERAS) protocols recommend having patients drink a carbohydrate-
rich surgical nutritional beverage a couple hours before procedures.
Many members of your staff might not be aware of enhanced recov-
ery or pre-op nutrition, or resistant to the idea on principle, especially
if NPO has been their standard practice for years or decades. "You
have to take a psychosocial approach and realize that not everyone is
going to buy into this very quickly," says Ms. Chappell. "To me, the
2 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J U L Y 2 0 1 9
