Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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M A R C H 2 0 1 6 • O U T PA T I E N TS U R G E R Y. N E T • 4 9 If enough patients complained about being parched and famished on the day of surgery, would you ease your fasting guidelines so that they could drink and eat a little on the morning of their procedures? The Heart of the Rockies Regional Medical Center in Salida, Colo., tried to do so last year, shelving its longstanding NPO-after-midnight blanket policy and adopting the American Society of Anesthesiologists' kinder, gentler 1999 pre-operative fasting guidelines: 6 hours for easily digested solids and 2 hours for clear liquids. "Patients were coming in complaining, 'We're starving!' We wanted to change to less- stringent guidelines because patients are happier and they do better when they can have fluids and food," says Scott Shaffer, DNAP, CRNA, a nurse anesthetist at Heart of the Rockies. "I subscribe to the new [ASA] guidelines. I think they're valid and good." But the switch was, in the words of Dr. Shaffer, "a huge disaster." Patients were eating in the waiting room and chugging 64 oz. of orange juice with pulp (clearly not a clear liq- uid!) 2 hours before surgery, says Dr. Shaffer. "This policy was a huge disaster since it was very common for patients to get confused on what I think are simple guidelines: 2 hours for clear liquids and 6 hours for light fare," says Dr. Shaffer. "We tried it, but it didn't work. That's why we went back to the simple policy of NPO after midnight." After 3 months of frustration and lots of canceled cases, the 3-OR hospital pulled the plug on the ASA fasting policy and reverted back to strict NPO after midnight for all patients. "Although if we're asked about it," admits Dr. Shaffer, "it's NPO 8 hours before surgery." What went wrong? For one, it was tough to get schedulers, nurses, anesthetists and sur- geons to consistently explain the new fasting guidelines to patients. "It was a juggling act," says Dr. Shaffer. Perhaps a bigger factor, he says, was that I CAN'T EAT OR DRINK AFTER MIDNIGHT is ingrained in the public's mind. Deviating from that created confusion. "That's the stan- dard," says Dr. Shaffer. "When you change the standard, you need a strong educational effort. Midnight is so easy to remember. It keeps it so simple for patients." — Dan O'Connor 'A HUGE DISASTER' Inside a Hospital's Failed Attempt to Change Its Fasting Instructions