Frequency and Appropriateness of Fasting Orders in the Hospital

Atsushi Sorita, Charat Thongprayoon, Adil Ahmed, Ruth E. Bates, John T. Ratelle, Katie M. Rieck, Aditya P. Devalapalli, Meltiady Issa, Riddhi M. Shah, Miguel A. Lalama, Zhen Wang, Mohammad H Murad, Deanne T. Kashiwagi

Research output: Contribution to journalArticle

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Abstract

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. Patients and 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. Conclusion 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.

Original languageEnglish (US)
Pages (from-to)1225-1232
Number of pages8
JournalMayo Clinic Proceedings
Volume90
Issue number9
DOIs
StatePublished - Sep 1 2015

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Meals
Fasting
Hospital Medicine
Patients' Rooms
Mouth
Inpatients
Length of Stay
Medicine

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Sorita, A., Thongprayoon, C., Ahmed, A., Bates, R. E., Ratelle, J. T., Rieck, K. M., ... Kashiwagi, D. T. (2015). Frequency and Appropriateness of Fasting Orders in the Hospital. Mayo Clinic Proceedings, 90(9), 1225-1232. https://doi.org/10.1016/j.mayocp.2015.07.013

Frequency and Appropriateness of Fasting Orders in the Hospital. / Sorita, Atsushi; Thongprayoon, Charat; Ahmed, Adil; Bates, Ruth E.; Ratelle, John T.; Rieck, Katie M.; Devalapalli, Aditya P.; Issa, Meltiady; Shah, Riddhi M.; Lalama, Miguel A.; Wang, Zhen; Murad, Mohammad H; Kashiwagi, Deanne T.

In: Mayo Clinic Proceedings, Vol. 90, No. 9, 01.09.2015, p. 1225-1232.

Research output: Contribution to journalArticle

Sorita, A, Thongprayoon, C, Ahmed, A, Bates, RE, Ratelle, JT, Rieck, KM, Devalapalli, AP, Issa, M, Shah, RM, Lalama, MA, Wang, Z, Murad, MH & Kashiwagi, DT 2015, 'Frequency and Appropriateness of Fasting Orders in the Hospital', Mayo Clinic Proceedings, vol. 90, no. 9, pp. 1225-1232. https://doi.org/10.1016/j.mayocp.2015.07.013
Sorita A, Thongprayoon C, Ahmed A, Bates RE, Ratelle JT, Rieck KM et al. Frequency and Appropriateness of Fasting Orders in the Hospital. Mayo Clinic Proceedings. 2015 Sep 1;90(9):1225-1232. https://doi.org/10.1016/j.mayocp.2015.07.013
Sorita, Atsushi ; Thongprayoon, Charat ; Ahmed, Adil ; Bates, Ruth E. ; Ratelle, John T. ; Rieck, Katie M. ; Devalapalli, Aditya P. ; Issa, Meltiady ; Shah, Riddhi M. ; Lalama, Miguel A. ; Wang, Zhen ; Murad, Mohammad H ; Kashiwagi, Deanne T. / Frequency and Appropriateness of Fasting Orders in the Hospital. In: Mayo Clinic Proceedings. 2015 ; Vol. 90, No. 9. pp. 1225-1232.
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abstract = "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. Patients and 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. Conclusion 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.",
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AU - Thongprayoon, Charat

AU - Ahmed, Adil

AU - Bates, Ruth E.

AU - Ratelle, John T.

AU - Rieck, Katie M.

AU - Devalapalli, Aditya P.

AU - Issa, Meltiady

AU - Shah, Riddhi M.

AU - Lalama, Miguel A.

AU - Wang, Zhen

AU - Murad, Mohammad H

AU - Kashiwagi, Deanne T.

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N2 - 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. Patients and 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. Conclusion 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.

AB - 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. Patients and 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. Conclusion 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.

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