The Common Practice of NPO at Midnight Prior to Surgical Procedures

The Common Practice of NPO at Midnight Prior to Surgical Procedures


Name: Carley Chandler

Rank: 1LT

Presenter/Poster: Both

Year: 2019


Description of the Project

This evidence based practice project sought to improve patient experience and reduce variation by implementing evidence-based preoperative fasting guidelines prior to surgical procedures.  


In surgical inpatients, does the implementation of the American Society of Anesthesiologists’ preoperative fasting guidelines compared to the standard NPO at midnight order reduce the variability of NPO time prior to surgery?


During their Clinical Nurse Transition Program, a group of staff nurses identified inconsistencies in the length of time surgical inpatients were NPO before surgeries. The standard order set defaulted to ‘NPO at midnight’ orders for the majority of patients, despite the differing times of scheduled surgeries. They conducted a literature review and identified the American Society of Anesthesiologist’ preoperative fasting guidelines. These guidelines establish ideal timelines for preoperative nutrition; the last large meal should be greater than 8 hours before surgery, the last light meal 6 hours prior to surgery, and clear liquids no less than 2 hours prior to surgery.

Baseline Findings

The team conducted a baseline assessment of patient actual NPO times prior to their surgeries over the past quarter. They found that only 18% of patients were NPO within 1-6 hours before surgery, which would meet the guidelines. An additional 63% of patients were NPO between 7-14 hours prior to surgery, and a surprising 19% of patients were NPO between 14-21 hours prior to their surgery.

Method of Implementation

The team identified multiple approaches to implement the standards. They initiated an education program to nursing, surgical, and anesthesia staff. Together with the Clinical Nurse Specialist, they have developed a standard order set for the electronic health record to guide surgeons. Once implemented on the inpatient unit, they plan to develop evidence-based patient education materials for ambulatory surgical areas to standardize practice. The team will reassess times patients are NPO prior to surgery 90 days after the implementation date. Results will be available by the time of the presentation.

Implications for Military Nursing

Increasing the number of patients who are NPO for the recommended period of time will enhance recovery for surgical inpatients, improve nutrition status, and improve patient satisfaction and experience.