Abstract

NM-233

Impact of improved parental education on cancellations due to NPO.

Miller R, Tumin D, Tobias J, Raman V, Raman V
Nationwide Children's Hosptial, Columbus, OH, USA

Background: Although fasting before surgery is necessary to decrease the risk of aspiration in pediatric patients undergoing general anesthesia, it is less stringent than previously (1). This relaxation of rules may actually lead to more confusion among families and health care providers. Non-compliance with preoperative fasting guidelines can lead to delays or cancellation of surgery, both of which can have negative economic and emotional implications for the patient and their families (2). We evaluated rates of case cancellations and delays related to nil per os (NPO) violations before and after an educational effort at our institution.

Methods: This study was exempt from Institutional Review Board approval as a quality assurance project. We evaluated delays and cancellations related to NPO at all anesthetizing locations in our institution in January-October 2016 to establish the pre-intervention rate. Beginning late 2016, we distributed a new NPO infographic educational tool in the hospital and in the community, and worked to revise nursing education related to NPO. We repeated the data query for January-October 2017 to determine whether delays and cancellations related to NPO have been reduced.

Results: We reviewed 42,314 cases in January-October 2016 and 47,307 cases in January-October 2017. In 2016, 175 (0.41%) cases were cancelled due to NPO while 113 (0.27%) were delayed due to NPO. In 2017, 184 cases (0.39%) were cancelled and 133 cases (0.28%) were delayed due to NPO. Site-specific rates of case cancellation and delay due to NPO are shown for each period in the Table. Overall, cancellation and delay rates due to NPO did not significantly decrease in the latter period (Chi-square p=0.560 and p=0.687, respectively); although a decrease in NPO-related cancellations was noted in off-site procedural locations other than the dental clinic (from 0.61% to 0.25% of cases, p=0.002).

Conclusions: Non-compliance with fasting guidelines remains a huge burden to the pediatric anesthesiologist and to patients and their families. We strive to educate not only our families, but also our health care team to provide the most accurate information related to NPO guidelines, to avoid unforeseen delays and cancellations. Our next steps are to make sure families are truly receiving, viewing, and understanding our educational materials. Although our numbers do not reflect improvement, our 2016 compliance to documentation for reasons of cancellation and delay was decreased. Future numbers of NPO delays and cancellations maybe more accurate.

References:
1. Beazley B et al. Perianesth Nurs. 2016;31:36-40.
2. Tait A et al. J Clin Anesth. 1997;9:213-9.