WIP 65 - How Long Must We Wait? A Review of Adherence to Established NPO Guidelines

Publication Number: WIP 65.7669

Ellen C. Bouazizi, Corewell Health William Beaumont University Hospital Children's, Royal Oak, MI, United States; Anthony S. Hernandez, Beaumont Children's Hospital, Royal Oak, MI, United States; Shashi Sahai, Beaumont Children's Hospital, Troy, MI, United States; Kerry Peters. Mychaliska, Corewell Health East, Royal Oak, MI, United States

Background: Patients undergoing a procedure with anesthesia are required to be nil per os (NPO) for a defined period to reduce the risk of aspiration of gastric contents. In 2017, the American Society of Anesthesiologists (ASA) published guidelines for preoperative fasting, which allow for consumption of a full meal 8 hours before a procedure; non-human milk, light meal, and infant formulas 6 hours prior; breastmilk 4 hours prior; and clear liquids 2 hours prior to procedure. It is well known that these NPO guidelines are inconsistently applied to pediatric patients. The purpose of this study is to determine the percentage of pediatric patients undergoing anesthesia that have NPO times in accordance with the current established guidelines.

Objective: The purpose of this study is to determine the percentage of pediatric patients undergoing anesthesia that have NPO times in accordance with the current established guidelines.

Design/Methods: This IRB exempt study (#2024-032) is a retrospective chart review of patients admitted to the pediatrics floor from April 1, 2017, to April 30, 2023, who underwent a procedure requiring anesthesia. Inclusion criteria are patients aged 1-18 who are determined healthy, underwent a procedure with documentation of anesthesia start/stop times, an NPO order, and record of feeding type and time. Exclusion criteria were patients less than age 1 or older than 18 with pregnancy, obesity, diabetes, hiatal hernia, gastroesophageal reflux disease, ileus or bowel obstruction, enteral tube feeding or difficult airway, and those with incomplete documentation of NPO or diet order, feeding time, or anesthesia or procedure start and stop times. Patient encounters were extracted from the Epic electronic medical record that met inclusion criteria, first by anesthesia times and NPO order. Data management tool removed encounters with exclusion criteria. NPO times of included patient data encounters will be compared to established guidelines in four categories.