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Description
Practice Problem Non-compliance with perioperative fasting (NPO) instructions is an ongoing safety and operational challenge in pediatric day surgery. Day-of-surgery cancellations result in financial losses, with unproductive OR time costing $1,430-$2,025 per hour. NPO violations cause 4.5% - 13.6% of lost OR time in children's hospitals and are the third leading cause of elective surgery cancellations. At our pediatric hospital, NPO violations contribute to same-day surgical delays and cancellations, particularly in the high-volume Otolaryngology (ENT) service line. This Evidence-Based Practice (EBP) project sought to answer whether, among caregivers of pediatric patients scheduled for ENT Day surgery (P), implementing a health literacy-informed standardized visual education tool at the final touchpoint (I), compared with standard verbal and written NPO instructions (C), improves NPO compliance rates and reduces day-of-surgery cancellations and delays related to NPO violations (O)? Literature/Evidence A medical librarian assisted with a literature search, resulting in 19 papers appraised with AACN Levels of Evidence, with 16 included in this EBP Project. Databases searched were PubMed, CINAHL, and Cochrane Library, using terms like pediatric NPO compliance, preoperative fasting education, visual education tools, surgical cancellations for children, and health literacy perioperatively. Inclusion criteria: pediatric populations, published 2014-2024, in English. Articles with evidence levels III to V were reviewed. Literature indicates that patients or caregivers forget 40-80% of medical information immediately after consultation, with about half of this information being incorrect. Visual aids nearly double caregivers' ability to identify fasting reasons. Personalized instruction tools at home reinforce recall and enable review. Providing pre-calculated fasting stop times reduces caregiver confusion and unnecessary fasting. Practice Change An interprofessional team was engaged and included ENT clinic schedulers, perioperative staff, anesthesia providers, and surgical coordinators. A bilingual, health literacy-informed visual education tool was developed and added to the patient folder and given before surgery. The tool included visual fasting guidelines, writable fields for stop times, and a pre-surgery checklist. Staff received brief training to explain its use and promote caregiver engagement. Implementation/Pilot-Testing During planning and pilot testing, the visual tool was developed and reviewed for health literacy and bilingual accuracy. Future pilot testing would include providing the tool to caregivers at the final ENT visit. Existing standard of care education steps, like pre-op phone calls and electronic messages with NPO times, will remain unchanged. A process measure tracking tool will monitor patient distribution rates, with outcome data from routine peri-anesthesia documentation on surgery day using de-identified, aggregate data. Outcomes/Results The primary outcome would be measured by NPO compliance rates on the day of surgery, documented in preoperative assessments. Secondary outcomes include fewer NPO-related cancellations and delays. Process measures, like tool distribution among ENT Day surgery patients, will also be tracked. Recommendations/Conclusions Preliminary pilot shows that integrating a standardized visual education tool into routine ENT preoperative workflows is feasible and acceptable. Future testing could expand and adapt the tool across multiple pediatric surgical service lines and languages to improve patient safety and caregiver experience. Ongoing feedback can help refine its content and delivery, demonstrating that low-cost educational innovations effectively address health literacy gaps.
Publication Date
10-18-2026
Disciplines
Pediatric Nursing
Recommended Citation
Rivera, Alma, "Use of Standard Visual Education Tools to Improve NPO Compliance in Pediatric Day Surgery" (2026). EBP Fellowship. 27.
https://scholarlycollection.childrens.com/nursing-posters-tcuebp/27
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This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
