let healthy patients have clear liquids up until 6 hours before the pro-
cedure if it is a later-in-the-day procedure," says Mr. Swain.
Besides being easy to remember, there's not much magical about
fasting from midnight for healthy patients undergoing elective proce-
dures. At the very least, for many patients, it is perpetuating a miser-
able pre-operative experience. "Are we so pro-midnight because mid-
night is the way we have always done it or is it because it is just easier
to tell everyone midnight?" asks Beverly Kirchner, RN, BSN, CNOR,
CASC, president and CEO of Genesee Associates in Southlake, Texas.
Bend but don't break
Despite evidence and recommendations to the contrary, nurses and
anesthetists have long been telling patients to strictly fast once the
clock strikes 12 on the day of their procedures, but some facilities are
bending the rules just a bit, our survey found.
The Pend Oreille Surgery Center in Ponderay, Idaho, bases fasting
instructions on the schedule. "We tailor the instructions to the
patients and the time of their arrival," says Kris Sabo, RN, the execu-
tive director. "We instruct that they discontinue solids 8 hours prior
to arrival to our center and they may consume clear liquids up until 3
hours prior to arrival. This gives us a little cushion. Should they need
to be moved up in the schedule, they will still meet the 6-hour solid
and 2-hour clear liquid NPO guidelines."
It's not uncommon for patients that are scheduled later in the day to
get individualized cutoff times for clear liquids based on their start
times. "It depends on the case and if the patient calls ahead of time,"
says Patti Glassey, BSN, RN, CAPA, administrator of the Turk's Head
Surgery Center in West Chester, Pa. "RNs do the pre-op phone call the
day prior for what to eat and drink and cutoff times."
Another facility lets patients scheduled after 11 a.m. have 6 ounces
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