Can a patient take oral (PO) medications when they are nil per os (NPO) in the hospital?

Administration of Oral Medications in NPO Patients

Oral medications should not be administered to patients who are NPO (nil per os) in the hospital setting, and alternative routes of administration should be used until swallowing is formally assessed and found to be safe. 1

Understanding NPO Status and Medication Administration

NPO status is a medical instruction meaning "nothing by mouth" and is commonly used in hospital settings for various reasons including:

• Preparation for surgical procedures
• Risk of aspiration
• Gastrointestinal issues
• Swallowing difficulties

Key Guidelines for Medication Management in NPO Patients

• Medications should not be administered orally to patients who are NPO 1
• Alternative routes of administration should be utilized when patients cannot take medications orally 1
• A formal swallowing assessment should be completed before resuming oral intake, including medications 1

Alternative Medication Routes for NPO Patients

When a patient is NPO, medications can be administered through alternative routes:

• Intravenous (IV)
• Intramuscular (IM)
• Subcutaneous
• Nasogastric tube (NGT) or other enteral feeding tubes
• Rectal
• Transdermal
• Sublingual (in some cases)

Special Considerations for Specific Patient Populations

Patients with Diabetes

For NPO diabetic patients:

• Basal insulin or a basal plus bolus correction insulin regimen is the preferred treatment 2
• Sliding scale insulin alone (without basal insulin) is discouraged 2
• Blood glucose monitoring should be performed every 4-6 hours in patients who are not eating 2

Patients with Acute Gout

For NPO patients with acute gout:

• Intra-articular injection of corticosteroids is recommended for involvement of 1-2 joints 2
• Intravenous or intramuscular methylprednisolone at an initial dose of 0.5-2.0 mg/kg is appropriate 2
• Subcutaneous synthetic adrenocorticotropic hormone (ACTH) at an initial dose of 25-40 IU is an alternative 2

Patients with Swallowing Difficulties

• Patients with suspected bronchoaspiration or dysphagia should remain NPO until a formal swallowing evaluation is performed 1
• Medications should not be administered orally until swallowing has been formally assessed and found to be normal 1

Common Pitfalls and How to Avoid Them

1. Inappropriate medication administration:

   • Never administer oral medications to NPO patients without proper assessment 1, 3
   • Avoid assuming that "NPO" only applies to food and not medications 3

2. Lack of standardized guidance:

   • Follow hospital-specific protocols for medication administration in NPO patients 3
   • Clarify NPO orders if they are ambiguous regarding medication administration 3

3. Medication errors with nasogastric tubes:

   • Not all oral medications can be safely crushed and administered via NGT 4
   • Consider drug stability, interaction with enteral nutrition, and potential tube obstruction 4

4. Nutritional compromise:

   • Ensure adequate nutrition is provided through alternative routes when patients are NPO 5
   • Nutritional compromise can occur within 2-3 weeks if adequate nutrition is not provided 1

Decision-Making Algorithm for Medication Administration in NPO Patients

1. Confirm NPO status and reason (surgical preparation, aspiration risk, etc.)
2. Review each medication for:
   • Clinical necessity during NPO period
   • Available alternative routes
   • Potential to hold temporarily
3. For essential medications:
   • Convert to parenteral form if available
   • Consider transdermal or other non-oral routes
   • Consult pharmacy for appropriate alternatives
4. Document all medication changes and rationale
5. Reassess NPO status daily and resume oral medications when appropriate and safe

By following these guidelines, healthcare providers can ensure patient safety while maintaining necessary medication therapy during periods when oral intake is restricted.