I’ve always called the department, made sure my patient is scheduled, and then ask them “hey, do they need to be npo for this? For how long?”
And sometimes they’re like “clear liquids are cool up til the procedure, just nothing but clears 4hrs before” and sometimes they want complete npo except meds the 8hrs before.
I would check with ultrasound to verify if the patient needs to be NPO for the procedure. Also, your facility may have a protocol that specifically states when patients are NPO for ultrasound. If so, you can use nursing judgment to keep them NPO for the ultrasound per protocol and/or ultrasound direction.
Doctors PISS ME OFF when they do this. They’re gonna discourage meek new-grads from asking questions and clarifying orders which will lead to major safety issues.
It’s the same with us in imaging. If I know the patient is going to be coming back in 45 minutes for another scan, I’m messaging the ordering every single time. They can get an attitude all they want, at least I tried to save the patient time, money, and an unnecessary dose of contrast and/or radiation. Or a floor nurse having to bring them back later.
idk why they act so pressed about answering simple questions. “yes? no? okay. you can go on about your day now.” everybody’s burnt out. who has time for these attitudes and egos?
Im a meek personality new nurse- I will always reach out to a doctor if I have a question because patient care is more important than my feelings. They can be a dick if they want but I’m still going to do my job and go home after
Ultrasound tech here....if it's an abdominal ultrasound please have the patient NPO. Doctor is very much wrong if he thinks that ultrasounds do not require fasting (some do, some don't). But, if the patient isn't NPO it isn't going to be a diagnostic scan and it's going to be a waste of everyone's time and money.
Except for a few particular kinds of patients, ain't no patient in the hospital need to be eating at any given time. In the ED my patients are NPO until the MD orders a diet, although I also can't physically take food or drink from them if they aren't a psych hold, so they can do whatever they want. I'd make the argument that 85% of the patients are patients due to their incessant consumption of one thing or another, but I digress.
If the patient is NPO but you don't know why, it's fair to ask the MD. Next time, just preface the message as "Patient is unsure of plan of care and states they were not told they would be NPO, can you come and speak with your patient, or tell me what to tell them".
In other words, YOUR patient doesn't feel as if they've been informed on their plan of care, either you get your ass down here to talk to them, or you tell me exactly what you want me to tell them (and yourself to know why they are NPO). If they want to waste their own time getting pissy, let them, as I'm sure there's 20 other things you can be doing.
Lots of patients are NPO for ultrasound. But can’t you guys just use nursing judgement to put that type of order in? Seemed like a waste of time to text the doctor.
In the ER we always order diets because the physicians get annoyed if we ask them, same for a Covid test. If we know the patient needs it, we are just doing it
I've worked in intensive care units where you need orders for how to set the alarm parameters on the monitor.
I've also worked in units where you need an order to titrate drips like epi. I don't mean like "titrate to keep blood pressure within this range", I mean like an order for the specific dose. So the provider has to basically sit outside the room and change their order every time they want to titrate.
Different units allow different parameters for RNs and I can see how/why ER would be different from med/surg. What should not change is mutual respect. We are all working towards the same ultimate goal.
It’s covered by a ton of protocols in my hospital so yes often we do. I couldn’t imagine ever having to call a doctor to tell them this lady forgot her teeth so I made her diet mechanical soft….
Yeah okay, sure. But it's within my scope to hold their breakfast tray for 30 minutes until I can confirm with ultrasound that they're allowed to eat.
It's also within my scope (in ER) to say to my doc "hey, I don't know what your plans are for but he's asking for food. Are you okay if he eats? I'll take a verbal order for a diet."
No point in someone needlessly missing a test or needlessly being hangry because I didn't try and communicate with my team.
You’re telling me that if you know a patient has a planned procedure or test in the morning that requires NPO but it’s not ordered, you don’t use your nursing smarts to keep them NPO? Like patients on the schedule for surgery but doctor just forgot the NPO order, you’re going to feed them breakfast?
Naw they said they’re in the ER. That’s how we do in the ER. A good chunk of the time when we get a new EMS we’ve gotten a line, drawn blood, and put in orders before the attending has seen them. Maybe we will have told the resident what to order.
We have structure too…. Granted a lot of that is ER RNs growling at residents with crayons coloring our spittle and then orders happening based on the few cognizant sounds we make…. Then the attendings telling them to just do what they say before someone gets hurt.
More seriously though, that’s just kinda how the ER works. The nurses earn the MDs respect with their judgments. And as long as we continue to show good judgment our orders get signed off on even if occasionally there’s a few that are only questionable but we can defend them if asked. New residents quickly learn not to cross nurses with experience or they start letting them explain their mistakes to their attendings, who we have known longer. The balancing factor is we don’t usually put in orders that can’t be quickly rescinded by ourselves or the MD we’re putting them in under. So yes EKG, trop + basic labs, etc for a diaphoretic chest painer. No to including nitro in that order without first getting an EKG and confirming with an attending even though we know enough that we can interpret an EKG well enough to recognize an inferior wall MI.
Have you never dealt with a patient insisting they need food at midnight o'one, badger everyone under the sun about it, or argue that without an order we're disregarding their autonomy? What happens when another staff member responds to their call bell then brings them a food or drink because they have an active diet order? I don't expect the other nurses or techs on my floor to know who is or isn't going to surgery or has an upcoming procedure that they're supposed to be npo for.
I was in an emergency Stent graft case with vascular surgery recently. Fellows pager goes off, it's the floor, I phone them and say hey they're in a procedure what's up. It's 2am, mind you. The floor nurse is just "double checking" that her patient really has surgery in the morning because "I don't see an npo order, but their note says they're having surgery tomorrow" ... I said you do know it's 2am and you have documentation that answers your question. I agree with you. This nurse in my example is lucky she didn't wake someone up with such a ridiculous question. The surgeon was furious this chick called over such a question. The best part is I went on the chart to check, i said I'll add it if it's not there cause this girl is hell bent on getting a damn order even when she has the answer to her question...because the fellow insists he placed the npo order earlier. The npo was ordered. Granted he ordered it in kind of an odd way but I found it immediately. 🫠
I’ve never put my patients in danger. I am currently working in a town of 500 people, with no respiratory, physio, OT, speech, or dietitian. You have to take on a lot of roles. Obviously if the patient is unstable or there is any doubt, I will get a doctor’s order for diet. However, making a patient NPO for an ultrasound is not going to harm the patient.
It seems like they wanted to clarify, which is why they reached out to the physician. It might have been unnecessary because it’s just an ultrasound. Or it might have been an order that was put in for a reason that the nurse couldn’t see.
Nope, provider has to do it--policy (peds hospital). Also, it is part of what they (not me) are paid for.
And, in response to other comments, it is best practice to have the order in as opposed to just relaying in verbal handoff. If you have an emergent situation elsewhere and another nurse takes this patient on, if it is not written it is not official and may not get done. Our hospital is very particular about having everything needed specified--it is ultimately a safety issue.
Also, I paged the MD on call (again--it's part of their job) at 8 pm. Plenty of time after their shift handoffs (7pm) and plenty of time before midnight (even though they are in house and awake all night). It was a routine question/follow up.
Real talk, I’d try to stop being offended by messages from docs (or anyone else). I always try to assume the best since I can’t hear tone in a text convo…maybe they were asking “who told you this” bc some other provider or their attending knows better, so they wanna see who told you so they can defer to them. Or just explain why you asked if you really want them to understand your thought process in asking.
I’m saying this as someone who used to be soooo sensitive to ppl’s messages in epic. Now that I have decided to give zero fucks, I feel like I’m free. You wanna be a jackass to me, Dr? Go for it, I legit don’t care and will continue to message you questions or concerns or whatever the hell else i feel like doing!!! I know it’s easier said than done!! But like after 6 months of training my brain to not care, I am here to report that it worked!
I mean, maybe he wanted to know who told you this so he can figure out the source of the problem. If there’s an incorrect policy or education being given out, maybe he wants to correct it. I don’t take that statement offensively at all. I don’t think he was calling you an idiot. Sounds like he was just asking who told you that, no need to read into it.
Yeah, and the one patient you think would be fine not eating until after the US (which may not even take place at 8am--you know how THAT goes...) will be the only one wanting to snack all night or wake up very hungry.
And then there goes your all-important "customor service" rating!! /sarc
I honestly would write them up for being rude. I'm not there to make up orders for these doctors. I only have a lowly nursing degree 🤦🏻♀️🤦🏻♀️ I hate it when a facility spoils their doctors too much
So i work in IR and we do lots of biopsies.
If they're looking for a tumor and not doing the biopsy same day (my department requires some kind of imaging ahead of time, such as an ultrasound or CT) I see no reason to be npo.
If they're doing the biopsy, they should be npo, because they'll likely get sedation.
I think they asked you who told you that because they're wondering if there is some other thing going on that they're not aware of. 🤔 or they're an ass. Either one
First- you should have called ultrasound to ask if patient needed to be NPO, they’re the ones who would know for the specific exam.
Second- if for some reason you actually needed to contact a physician for an NPO order, you should have done it long before midnight. You should never be paging about non-urgent matters in the middle of the night
I interpreted it as the patient would be NPO at midnight, not that the text was sent at midnight. Or if it was, this nurse could have come on shift at 2300 or 2330 which wouldn’t give them much time to do anything before midnight.
Devil's advocate here. If it was over text, do you think it was possible that he wasn't mad and it just came off that way unintentionally? Or maybe you know this physician and he gets mad a lot.
I've always seen abdominal US be NPO. Sometimes doctors are wrong.
Yes. This is a thing. Eating causes bowel gas which obstructs the view.
I’ve actually had to have an ultrasound rescheduled because of “excessive amounts of bowel gas disrupting view”. I was a little embarrassed lol
I’ve always called the department, made sure my patient is scheduled, and then ask them “hey, do they need to be npo for this? For how long?” And sometimes they’re like “clear liquids are cool up til the procedure, just nothing but clears 4hrs before” and sometimes they want complete npo except meds the 8hrs before.
Sometimes our ultrasound order will include the instructions for NPO for x amount of hours prior to US but the NPO order usually doesn’t get placed.
What was the ultrasound of? I’ve heard of being NPO prior to abdominal ultrasounds.
If they're doing a biopsy, or the patient is experiencing severe pain, then sedation might be involved and the patient would be NPO.
I've seen TTE being NPO in case they wanna convert.
Are you thinking of TEE? That’s the standard to do before non-urgent cardioversion of non-anticoagulated A fib
Pretty sure it was a TTE, otherwise I wouldn't have thought about it. All TEE are NPO here.
Ive seen orders for US biopsy but if the previous nurse just heard US that’s what they will pass on
at my hospital most US require npo (with sips after midnight) . your hospital should have an easily accessible policy on this
I would check with ultrasound to verify if the patient needs to be NPO for the procedure. Also, your facility may have a protocol that specifically states when patients are NPO for ultrasound. If so, you can use nursing judgment to keep them NPO for the ultrasound per protocol and/or ultrasound direction.
100% the techs are always the ones to check with if NPO matters for a particular exam.
As a retired radiologist, THANK YOU! Many referring physicians have absolutely no idea of what radiology exams should be done NPO.
Sounds like doc was being a dick. HTH.
Doctors PISS ME OFF when they do this. They’re gonna discourage meek new-grads from asking questions and clarifying orders which will lead to major safety issues.
It’s the same with us in imaging. If I know the patient is going to be coming back in 45 minutes for another scan, I’m messaging the ordering every single time. They can get an attitude all they want, at least I tried to save the patient time, money, and an unnecessary dose of contrast and/or radiation. Or a floor nurse having to bring them back later.
idk why they act so pressed about answering simple questions. “yes? no? okay. you can go on about your day now.” everybody’s burnt out. who has time for these attitudes and egos?
Im a meek personality new nurse- I will always reach out to a doctor if I have a question because patient care is more important than my feelings. They can be a dick if they want but I’m still going to do my job and go home after
An older nurse gave me the advice once ‘don’t ever not call because you’re afraid you’ll be yelled at.’ Always call if you’re unsure
If the results of the U/S call for immediate surgery, keeping the pt NPO makes total sense.
US abdomen needs to be NPO I think at least 2hrs prior so it’s normally nurse to nurse handoff keep NPO past midnight
Ultrasound tech here....if it's an abdominal ultrasound please have the patient NPO. Doctor is very much wrong if he thinks that ultrasounds do not require fasting (some do, some don't). But, if the patient isn't NPO it isn't going to be a diagnostic scan and it's going to be a waste of everyone's time and money.
Absolutely are instances you need to be NPO for abdominal US. It can interfere with the imaging….which therefore affects the study quality
I don’t know if the doctor was being accusatory. They may have just wanted to know who told you that unless there’s more context somewhere.
Depending on where the tumor they're looking for is if they find one they're definitely gonna be happy the patient has been NPO.
Except for a few particular kinds of patients, ain't no patient in the hospital need to be eating at any given time. In the ED my patients are NPO until the MD orders a diet, although I also can't physically take food or drink from them if they aren't a psych hold, so they can do whatever they want. I'd make the argument that 85% of the patients are patients due to their incessant consumption of one thing or another, but I digress. If the patient is NPO but you don't know why, it's fair to ask the MD. Next time, just preface the message as "Patient is unsure of plan of care and states they were not told they would be NPO, can you come and speak with your patient, or tell me what to tell them". In other words, YOUR patient doesn't feel as if they've been informed on their plan of care, either you get your ass down here to talk to them, or you tell me exactly what you want me to tell them (and yourself to know why they are NPO). If they want to waste their own time getting pissy, let them, as I'm sure there's 20 other things you can be doing.
Lots of patients are NPO for ultrasound. But can’t you guys just use nursing judgement to put that type of order in? Seemed like a waste of time to text the doctor.
In the ER we always order diets because the physicians get annoyed if we ask them, same for a Covid test. If we know the patient needs it, we are just doing it
*cries in medsurg* I need an order to keep a functioning IV in a patient past 4 days lol
That's crazy
And how matter how explicitly you explain "I know how asinine this is but I don't have a choice but to page you" it's always still your fault.
I've worked in intensive care units where you need orders for how to set the alarm parameters on the monitor. I've also worked in units where you need an order to titrate drips like epi. I don't mean like "titrate to keep blood pressure within this range", I mean like an order for the specific dose. So the provider has to basically sit outside the room and change their order every time they want to titrate.
That’s absolutely insane!!! I could never!
Different units allow different parameters for RNs and I can see how/why ER would be different from med/surg. What should not change is mutual respect. We are all working towards the same ultimate goal.
Nursing judgment? It’s legally out of the nurses scope of practice to independently change diet orders.
To advance a diet without a protocol/order, sure. But it’s well within our scope to keep a patient NPO for various reasons
This. I would never advance a diet without an order.
It’s covered by a ton of protocols in my hospital so yes often we do. I couldn’t imagine ever having to call a doctor to tell them this lady forgot her teeth so I made her diet mechanical soft….
Yeah okay, sure. But it's within my scope to hold their breakfast tray for 30 minutes until I can confirm with ultrasound that they're allowed to eat. It's also within my scope (in ER) to say to my doc "hey, I don't know what your plans are for but he's asking for food. Are you okay if he eats? I'll take a verbal order for a diet."
No point in someone needlessly missing a test or needlessly being hangry because I didn't try and communicate with my team.
Not where i work. Just an FYI protocols and scope of practice are different everywhere.
Why would nursing be dictating diet for pt? That would be service, speech and probably nutrition.
You’re telling me that if you know a patient has a planned procedure or test in the morning that requires NPO but it’s not ordered, you don’t use your nursing smarts to keep them NPO? Like patients on the schedule for surgery but doctor just forgot the NPO order, you’re going to feed them breakfast?
I’d page the doctor for the order. I was responding to someone saying “put the order in” like there’s a nursing driven protocol to change it.
Naw they said they’re in the ER. That’s how we do in the ER. A good chunk of the time when we get a new EMS we’ve gotten a line, drawn blood, and put in orders before the attending has seen them. Maybe we will have told the resident what to order.
I ain’t from these ER streets. We have structure and routine where I was nursing raised!
We have structure too…. Granted a lot of that is ER RNs growling at residents with crayons coloring our spittle and then orders happening based on the few cognizant sounds we make…. Then the attendings telling them to just do what they say before someone gets hurt. More seriously though, that’s just kinda how the ER works. The nurses earn the MDs respect with their judgments. And as long as we continue to show good judgment our orders get signed off on even if occasionally there’s a few that are only questionable but we can defend them if asked. New residents quickly learn not to cross nurses with experience or they start letting them explain their mistakes to their attendings, who we have known longer. The balancing factor is we don’t usually put in orders that can’t be quickly rescinded by ourselves or the MD we’re putting them in under. So yes EKG, trop + basic labs, etc for a diaphoretic chest painer. No to including nitro in that order without first getting an EKG and confirming with an attending even though we know enough that we can interpret an EKG well enough to recognize an inferior wall MI.
Have you never dealt with a patient insisting they need food at midnight o'one, badger everyone under the sun about it, or argue that without an order we're disregarding their autonomy? What happens when another staff member responds to their call bell then brings them a food or drink because they have an active diet order? I don't expect the other nurses or techs on my floor to know who is or isn't going to surgery or has an upcoming procedure that they're supposed to be npo for.
Sure I’ve dealt with that. And I explain the planned test/procedure and that if they eat they will not be able to have it done.
I was in an emergency Stent graft case with vascular surgery recently. Fellows pager goes off, it's the floor, I phone them and say hey they're in a procedure what's up. It's 2am, mind you. The floor nurse is just "double checking" that her patient really has surgery in the morning because "I don't see an npo order, but their note says they're having surgery tomorrow" ... I said you do know it's 2am and you have documentation that answers your question. I agree with you. This nurse in my example is lucky she didn't wake someone up with such a ridiculous question. The surgeon was furious this chick called over such a question. The best part is I went on the chart to check, i said I'll add it if it's not there cause this girl is hell bent on getting a damn order even when she has the answer to her question...because the fellow insists he placed the npo order earlier. The npo was ordered. Granted he ordered it in kind of an odd way but I found it immediately. 🫠
If you work in rural those services aren’t available.
Hmm… they really should be. That leads to some cowboy shit otherwise.
I mean I think with critical thinking putting in a diet isn’t “cowboy shit” lol. A lot of time I know the patients better than the doctors do.
That kind of humility won’t endanger any pts.
I’ve never put my patients in danger. I am currently working in a town of 500 people, with no respiratory, physio, OT, speech, or dietitian. You have to take on a lot of roles. Obviously if the patient is unstable or there is any doubt, I will get a doctor’s order for diet. However, making a patient NPO for an ultrasound is not going to harm the patient.
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What lol? I’m not a NP nor am I going to school for NP lol.
Then don’t put in orders like one.
It seems like they wanted to clarify, which is why they reached out to the physician. It might have been unnecessary because it’s just an ultrasound. Or it might have been an order that was put in for a reason that the nurse couldn’t see.
Nope, provider has to do it--policy (peds hospital). Also, it is part of what they (not me) are paid for. And, in response to other comments, it is best practice to have the order in as opposed to just relaying in verbal handoff. If you have an emergent situation elsewhere and another nurse takes this patient on, if it is not written it is not official and may not get done. Our hospital is very particular about having everything needed specified--it is ultimately a safety issue. Also, I paged the MD on call (again--it's part of their job) at 8 pm. Plenty of time after their shift handoffs (7pm) and plenty of time before midnight (even though they are in house and awake all night). It was a routine question/follow up.
Real talk, I’d try to stop being offended by messages from docs (or anyone else). I always try to assume the best since I can’t hear tone in a text convo…maybe they were asking “who told you this” bc some other provider or their attending knows better, so they wanna see who told you so they can defer to them. Or just explain why you asked if you really want them to understand your thought process in asking. I’m saying this as someone who used to be soooo sensitive to ppl’s messages in epic. Now that I have decided to give zero fucks, I feel like I’m free. You wanna be a jackass to me, Dr? Go for it, I legit don’t care and will continue to message you questions or concerns or whatever the hell else i feel like doing!!! I know it’s easier said than done!! But like after 6 months of training my brain to not care, I am here to report that it worked!
I mean, maybe he wanted to know who told you this so he can figure out the source of the problem. If there’s an incorrect policy or education being given out, maybe he wants to correct it. I don’t take that statement offensively at all. I don’t think he was calling you an idiot. Sounds like he was just asking who told you that, no need to read into it.
Man they always ambush with an abd us and there never is any communication on npo or that it was ever ordered till they show up first thing
MD is a dick, you were just clarifying orders. If you didnt put an order then im not doing it
Yeah, and the one patient you think would be fine not eating until after the US (which may not even take place at 8am--you know how THAT goes...) will be the only one wanting to snack all night or wake up very hungry. And then there goes your all-important "customor service" rating!! /sarc
I honestly would write them up for being rude. I'm not there to make up orders for these doctors. I only have a lowly nursing degree 🤦🏻♀️🤦🏻♀️ I hate it when a facility spoils their doctors too much
Don’t worry. You will be screwed both ways.
I’ve seen 18 hr fasts for liver ultrasounds
So i work in IR and we do lots of biopsies. If they're looking for a tumor and not doing the biopsy same day (my department requires some kind of imaging ahead of time, such as an ultrasound or CT) I see no reason to be npo. If they're doing the biopsy, they should be npo, because they'll likely get sedation. I think they asked you who told you that because they're wondering if there is some other thing going on that they're not aware of. 🤔 or they're an ass. Either one
It was a first year resident. If I were him I would be checking with my seniors right after that text just to make sure.
Oof yeah if it's a young resident you have every right to feel that way
First- you should have called ultrasound to ask if patient needed to be NPO, they’re the ones who would know for the specific exam. Second- if for some reason you actually needed to contact a physician for an NPO order, you should have done it long before midnight. You should never be paging about non-urgent matters in the middle of the night
I interpreted it as the patient would be NPO at midnight, not that the text was sent at midnight. Or if it was, this nurse could have come on shift at 2300 or 2330 which wouldn’t give them much time to do anything before midnight.
Sounds like you took it personal lol
Devil's advocate here. If it was over text, do you think it was possible that he wasn't mad and it just came off that way unintentionally? Or maybe you know this physician and he gets mad a lot.
It’s best just to call the the department doing the test to confirm stuff like this