Date of Graduation

Fall 12-2026

Document Type

Project

Degree Name

Doctor of Nursing Practice (DNP)

College/School

School of Nursing and Health Professions

Department/Program

Nursing

Program

Healthcare Systems Leadership DNP

First Advisor

Dr. Kelly Fox

Second Advisor

Dr. Cathy Coleman

Abstract

Background: Nil per os (NPO) guidelines are utilized for patient safety during procedures to reduce the risk of pulmonary aspiration. The American Society of Anesthesiologists (ASA) recommends clear liquids up to 2 hours before non-emergent procedures, although many facilities still implement the outdated practice of ordering NPO after midnight. This practice can lead to prolonged fasting, which may cause increased hunger, thirst, hypotension, nausea, and dizziness, ultimately resulting in patient dissatisfaction and discomfort.

Purpose: To review and assess current ASA NPO guidelines that describe best practice to enhance the patient experience without increasing perioperative risk of pulmonary aspiration.

Methods: A comprehensive literature search was conducted using three databases: PubMed, Scopus, and CINAHL to identify publications that currently reference the ASA NPO guidelines.

Results: Four themes were identified among the studies, including prolonged fasting, gastric volume and pH, patient outcomes, and barriers to change.

Conclusion: Initiation of NPO at midnight is no longer considered best practice. Current ASA NPO guidelines are recommended for implementation prior to non-emergent inpatient procedures.

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