Monday, February 23, 2009

Question for my fellow RN's

Recently I had a patient come down for surgery who had dementia and diabetes. The family had phoned in the surgery consent but were now bedside for the procedure. The patient was adamant that they had brought a breakfast tray into her, she had eaten eggs & bacon but they took it away from her before she could finish. The nurse had documented that the patient was NPO since MN the night before.

Even though the patient suffered from dementia her second proclamation of anger over her tray being taken away prior to her finishing the meal prompted the anesthesiologist to have the RN on the floor called to verify the NPO status.

When I called up to the unit, it was shift change and the new RN said that’s what she had been given in report but the other RN was still in the locker room. I asked her if she could please verify with me the NPO status. When the primary RN was being questioned I could hear her in the background, “NO the patient didn’t get a tray taken away! We did catch her with a couple of cookies from her own private stash but it was only one or two!... Tell them they were sugar free, good God.”

The anesthesiologist was livid! He wanted to know if that RN understood what NPO stands for. (To all OR nurses who have had to endure the brunt of misplaced frustration I know you can relate.) The surgeon came in, and because the surgery was for placement of a catheter for dialysis, it was late, and the patient needed to be dialyzed today went to the family and told them that we had to do the surgery or she could die…however she could die because she ate.

Anesthesia decided to do a rapid sequence intubation and continue on with the surgery. (At this point it had been 6 hours since the “cookies”) The MD wanted to make sure that a report of some kind was followed up on to make sure that some teaching was done to the RN on the floor. I asked if he wanted her “formally” written up or a verbal to my supervisor to take care of things. He stated that a verbal would be OK. I made a copy of the documentation and gave it to my supervisor. The next day, the anesthesiologist, went to her as well to follow up- prompting her to mandate that I do a formal incident report for teach only purposes.

I wonder if non-operating room nurses know/understand why it is so important that a patient be NPO prior to surgery? One anesthesiologist was talking to another one at the surgery desk and made the comment, “You know I heard a nurse tell a patient one time that the reason they were to be NPO is so that they don’t throw up after surgery… The patient drank thinking that it would be so bad to throw that up afterwards…”

Any thoughts? Any suggestions on teaching tools? Maybe I should make something…

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