Date of Graduation

Summer 8-14-2026

Document Access

Restricted Project/Capstone - USF access only

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Program

MSN project

First Advisor

Cynthia Huff

Abstract

NPO noncompliance is a patient safety concern, especially amongst neurological patients who are at high risk for dysphagia and aspiration, both of which contribute to longer lengths of hospitalization and increased medical costs (Rissardo & Caprara, 2024). In a medical system in Maryland, this microsystem is a 36-bed Emergency Department (ED) unit, serving diverse patient populations (Hospital A). In this medical system, a baseline audit reveals that 67% of the time, patients receive oral medication despite there being nothing by mouth (NPO) orders in place, signifying unsafe swallowing.

Within this microsystem, swallow screen documentation for patients with neurological complaints is required per protocol to identify patients at risk for pneumonia and guide safe oral intake decisions. When a nurse deems a patient unsafe for oral intake, an NPO order is placed, awaiting further evaluation by speech-language pathologists (SLP). Contributing factors to NPO non-compliance include competing clinical priorities, inconsistencies in understanding the SLP process, and workflow variability.

A quality improvement intervention was implemented in Hospital A over a 4-week period and included staff education, standardized communication regarding nil per os (NPO) status, weekly chart audits, and feedback to nursing staff and leadership. Process measures evaluated NPO noncompliance, defined as oral medication administered to patients with an NPO order without documented SLP swallowing clearance. Outcome measures were tracked in Hospital A for patients coming into the ED for neurological complaints. Following implementation, NPO order non-compliance decreased from 67% to 26%, exceeding the project goal of 33%. Nursing staff reported improved understanding of the swallow screen process and improved consistency in following protocols. These findings within 4 weeks suggest that an educational approach to swallow screen compliance and real-time feedback can significantly improve adherence to protocols and reduce instances of aspiration related compilations.

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