Department of Medicine, Division of Geriatrics and Palliative Care, The University of Texas Medical Branch, Galveston, Texas, USA.
The University of Texas Medical Branch, School of Medicine, Galveston, Texas, USA.
J Hosp Med. 2023 May;18(5):375-381. doi: 10.1002/jhm.13066. Epub 2023 Feb 20.
Pre-procedural fasting (nil per os [NPO]) is a commonly implemented protocol to prevent aspiration during certain diagnostic and therapeutic procedures. However, evidence suggests aspiration risk is quite low. Current guidelines support a reduced fasting duration before procedures necessitating anesthesia or sedation, but many health systems persist in the use of NPO past midnight.
We aimed to reduce the use of NPO p MN before inpatient diagnostic and therapeutic procedures necessitating anesthesia or sedation by 50% within 6 months.
DESIGN, SETTING AND PARTICIPANTS: We performed a quality improvement initiative at a single academic health system in Southeast Texas. We include the experience of patients of all ages across 4 affiliated hospitals (one main academic hospital and three community satellite hospitals).
An interprofessional team was convened to review best practices and oversee this quality improvement initiative. Diagnostic imaging protocols previously requiring NPO were amended to reflect evidence-based fasting requirements. A pre-procedure clear liquid diet was also implemented.
We describe the steps to implementation, feasibility of implementation as described through key process measures, and the safety of implementation (balancing measures).
NPO requirements were removed from 70% of existing diagnostic imaging and therapeutic orders. After these amended protocols and the implementation of a pre-procedure clear liquid diet, we displayed an immediate 50% reduction in NPO past midnight usage. Further stakeholder engagement/education and targeted interventions reduced NPO past midnight usage to only 33% of pre-procedural diet orders. Surgery remains the most common indication for continued use of NPO. Aspiration events and procedural delays were rare.
在某些诊断和治疗程序中，术前禁食（禁食，NPO）是一种常用的预防误吸的协议。然而，有证据表明误吸的风险很低。目前的指南支持在需要麻醉或镇静的程序前减少禁食时间，但许多卫生系统仍然坚持在午夜后禁食。
我们旨在在 6 个月内将需要麻醉或镇静的住院诊断和治疗程序前 NPO 的使用量减少 50%。
设计、地点和参与者：我们在德克萨斯州东南部的一家单一学术医疗系统中进行了一项质量改进计划。我们包括来自 4 家附属医院（一家主要的学术医院和三家社区卫星医院）的所有年龄段患者的经验。
一个多专业团队被召集来审查最佳实践，并监督这项质量改进计划。以前需要 NPO 的诊断成像协议被修改，以反映基于证据的禁食要求。还实施了术前清亮液体饮食。
我们描述了实施步骤、通过关键过程措施描述的实施可行性以及实施的安全性（平衡措施）。
70%的现有诊断成像和治疗订单中的 NPO 要求被删除。在这些修改后的协议和术前清亮液体饮食的实施后，我们立即将午夜后 NPO 的使用量减少了 50%。进一步的利益相关者参与/教育和有针对性的干预措施将午夜后 NPO 的使用量减少到术前饮食医嘱的 33%。手术仍然是继续使用 NPO 的最常见指征。很少发生误吸事件和程序延迟。
