To address the process of ordering and managing NPO orders on hospital units across the health authority.

At our health authority, varying practices for ordering and implementing NPO status were resulting in miscommunication of NPO status and diet orders to food services. With food services not being notified of NPO status, meal trays were sent leading to the cancellation of procedures and surgeries. We undertook stakeholder engagement to determine the factors contributing to this problem. Stakeholder engagement revealed that nursing staff were not communicating NPO orders to food services for fear of food not being available if NPO orders were cancelled late in the day. To address this, we worked with food services and nursing to pilot the provision of a set number of bagged meals on the pilot units. The bagged meals provided a source of food should an NPO order be cancelled. During the pilot, we tracked NPO orders and bag meal usage. Engagement also revealed that nurses were not aware of meal service processes, including cut off times for diet changes and the availability of late meal trays. To address this knowledge gap, food services prepared a communication to nursing staff on meal service processes, as part of the pilot. We also developed a clinical practice document (CPD) to outline the responsibilities of healthcare staff in managing and communicating NPO orders. We also included a standard definition for NPO. Upon completion of the pilot project, the CPD was finalized and the bagged meal program was modified to meet actual need.

Systematic approach used: Stakeholder engagement and pilot project were used toinform the CPD.

The development of a standard definition for NPO and documenting the process to order and manage NPO orders within a CPD will allow for consistent practice and improved patient care throughout the health authority.