Frequency and Appropriateness of Fasting Orders in the Hospital.
OBJECTIVE
To evaluate the frequency and appropriateness of nil per os (nothing by mouth) (NPO) orders and determine the number of meals missed because of these orders among hospitalized patients.


METHODS
We retrospectively analyzed inpatient NPO orders at an academic institution in the United States. The frequency and duration of NPO orders and the number of meals missed because of these orders were assessed for adult patients admitted to the hospital medicine services from January 1, 2013, through December 31, 2013, with a hospital stay of 2 or more and 30 or fewer days. Two blinded reviewers assessed if the order could be avoided or the period shortened for a random sample of NPO orders of 120 or more minutes' duration that were written for patients on the general medicine ward.


RESULTS
A total of 3641 NPO orders were identified. At least one NPO order was placed in 46.6% of the admissions (2211 of 4743). The median duration of NPO orders was 12.8 hours (interquartile range, 9.2-17.3 hours), resulting in 2 (interquartile range, 1-4) missed meals. Of 1130 NPO orders reviewed, 263 (23.3%; 95% CI, 20.9%-25.8%) were deemed avoidable (κ statistic, 0.68), and 482 (42.7%) were unavoidable but led to more missed meals than needed. Taken together, patients could have had 44.8% of the meals (1085 of 2424; 95% CI, 42.8%-46.7%) missed due to NPO orders.


CONCLUSIONS
Approximately half of the patients admitted to the hospital medicine services experienced a period of fasting. One in 4 NPO orders and nearly half of missed meals could have been avoided. Further study is warranted to assess the generalizability of our findings.
Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN. Electronic address: sorita-tky@umin.net.
Atsushi
A
Sorita
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
Charat
C
Thongprayoon
Wichita Falls Family Practice Residency Program, North Central Texas Medical Foundation, Wichita Falls.
Adil
A
Ahmed
Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN.
Ruth E
RE
Bates
Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN.
John T
JT
Ratelle
Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN.
Katie M
KM
Rieck
Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN.
Aditya P
AP
Devalapalli
Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN.
Meltiady
M
Issa
Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN.
Riddhi M
RM
Shah
Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN; Division of Digestive Diseases and Nutrition, Morsani College of Medicine, University of South Florida, Tampa.
Miguel A
MA
Lalama
Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
Zhen
Z
Wang
Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN.
M Hassan
MH
Murad
Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN.
Deanne T
DT
Kashiwagi
D000328:Adult; D001291:Attitude of Health Personnel; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005215:Fasting / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000458:organization & administration*; D010353:Patient Education as Topic / Q000379:methods; D011300:Preoperative Care / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D055815:Young Adult