We were pleased to see the 1999 guidelines of the American Society of Anesthesiologists (ASA) Task Force on Preoperative Fasting1 and our research highlighted in "Preoperative Fasting Doesn't Mean Nothing After Midnight" (Think Again, September). As author Sue Sendelbach notes, it's difficult to change the tradition of NPO (the Latin non per os or nil per os, meaning "nothing by mouth") after midnight, despite strong evidence for liberalizing preoperative fasting.
We applaud the staff of the Minneapolis Heart Institute at Abbott Northwestern Hospital for changing the standard NPO order to agree with the ASA guidelines, allowing patients to have clear liquids up to two hours before surgery. We wondered, however, why the policy for solid food wasn't changed to be congruent with these guidelines (that is, allowing a light breakfast, such as tea and toast, up to six hours before surgery). Scheduling changes are often used as a reason to maintain the solid food policy, as cited in our Point–Counterpoint article with Mark A. Warner in AJN ("Best Practices Shouldn't Be Optional," June 2002), which shows that many people overestimate the frequency of these changes. Hard data is needed to determine how common they really are. Perhaps this will be the next step. We agree that liberalizing clear liquids is more important than liberalizing solids.
In our research on preoperative fasting, we've discovered that policy and practice are quite different. Have the staff members at the Minneapolis Heart Institute interviewed patients to find out which fasting instructions they were given, and what they actually did?
It's been over a decade since the ASA guidelines were published. The safety and benefits of shortened fasting are clear. We've previously addressed the many excuses for clinging to NPO after midnight.2 Everyone advocates evidence-based practice, but words and action don't match. Is this another ritual that health care providers won't change but educated consumers eventually will?
Elizabeth H. Winslow, PhD, RN, FAAN
Jeannette T. Crenshaw, MSN, RN, LCCE, FACCE, IBCLC, NEA-BC
1. American Society of Anesthesiologists Task Force on Preoperative Fasting. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: a report by the American Society of Anesthesiologist Task Force on Preoperative Fasting. Anesthesiology
2. Winslow EH, et al. Best practices shouldn't be optional. Am J Nurs